• Thank you for requesting the ATM Depot forms package! 💪🙂 Inside this package, you will find the necessary forms to get your ATM Machine Program up and running. You can complete all required fields and sign the documents directly from your computer or mobile device. No need to print these out. Below is a checklist of items included with your ATM forms package.

    1. ACH Form: This 1-page form is required in order for us to deposit settlement funds back into your accounts. When someone withdraws cash from your ATM, the Interbank ATM Networks deduct the funds form the Customers Bank and sends the money back to your back account. This from is used to designate where you want your settlement funds and your passive income residuals deposited. An extra ACH Form is included in the package for those who share part of the surcharge and want us to send funds on your behalf. One ACH Form is required for every party that we pay. Voided checks are also required with this form.

    2. Wireless Agreement: This is optional but recommended 3-page form includes a wireless router for your ATM. This wireless router/model converts your ATM signal from the merchant’s internet to your own private cellular network, providing a super-fast, reliable connection to the networks so your ATM doesn’t have to rely on the merchant’s communications giving maximum uptime to make more money                    
       

     

     

  • ACH Authorization Form

  • Location Information

  • A registered location name and address are required for this ACH. If you don’t have a location yet, please use your business name and address (even if it’s your home) for now. If and when you need to update or change it to a merchant location, you can request a new ACH form when you are ready to install the ATM.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Surcharge Information

  • Surcharge Splits: Would you like to split the surcharge from your ATM between multiple parties? If you are sharing the surcharge with others and want us to pay them for you so you don't have to do that accounting or make the payments, we can!

    Here is how you tell us your Surcharge Splits:

    • List all payees receiving surcharge payment below
    • Payee #1 is required which is usually you, then select the "Additional Payees" box to enter up to two more payees
    • Each payee will need to complete an ACH form, provide a voided check for verification of banking information, and submit a W-9 before payment can be made directly.
      • The W-9 for Payee #1 is included below in this forms package
      • An additional ACH Authorization form can be found here or you can pass this link along to the other parties to fill it out themselves: https://forms.atmdepot.com/ach
        • Make sure he/she uses the same Location Name and Address
      • An additional W-9 form can be found here or you can pass this link along to the other parties as well: https://forms.atmdepot.com/w9
        • Payout Name should match Name on W-9
    • Additional Payees 
    • Section Closer 

    • Banking Information

    • Banking Information

      For Vault Cash Account

    • Banking Information

      For Surcharge / Income Account

    • Banking Information

      For Both Vault Cash & Surcharge / Income Account
    • Is this account for your vault cash, your surcharge commission, or both?*
    • Bank Account Type*

    • Banking Information

      For Vault Cash Account

    • Banking Information

      For Surcharge / Income Account
    • Bank Account Type

    • A VOIDED CHECK MUST BE INCLUDED WITH THIS FORM

      Any Payee listed above must provide a voided check or bank letter for ACH transfer and a signed ACH Authorization Form.

      It is the responsibility of the ATM Operator to verify that all information contained in the exhibits and all other forms submitted to Intelligent eCommerce, Inc (ATMDepot.com), or any modification thereof, are correct and complete. ATMDepot.com and/or its 3rd Party Service Providers has no responsibility to verify any such information and will not be responsible for any claims whatsoever related to any incorrect information submitted to ATMDepot.com. ATM Operator shall notify ATMDepot.com of any disputed item or items. ATMDepot and/or its 3rd Party Service Providers shall not be liable for any amounts which were transmitted in error over twenty-five (25) days prior to the date ATMDepot.com receives notice from ATM Operator, regardless of fault.

      I hereby authorize ATMDepot.com and/or its 3rd Party Service Providers to initiate ACH transfers for the following: adjustments, error corrections, chargebacks, daily settlements, maintenance, monthly commissions, and/or debit the account identified herein.

    • Voided Check / Bank Letter
      Drag and drop files here
      Choose a file
      Cancelof
    • Voided Check / Bank Letter for Vault Cash Acct
      Drag and drop files here
      Choose a file
      Cancelof
    • Voided Check / Bank Letter for Surcharge / Income Acct
      Drag and drop files here
      Choose a file
      Cancelof

    • For Second ACH

    • Is this account for your vault cash, your surcharge commission, or both?

  • 4G LTE ATM Wireless Plan

  • Do you need a Wireless Device?*
  • Wireless Device [Img]

  • Not Sure if You Need a Wireless Device? 
    We can help you decide!

    • Would you like to offer mobile events in your area?
    • Would you like your customers to experience the fastest transactions possible?
    • Do you want your ATM to remain in service even if the internet is out at your location?

    If you answered 'yes' to any of the questions above, you're going to need wireless devices for your locations and we've got you covered 🙂📶✅

    With ATM Depot's wireless ATM network technology we can set up an ATM just about anywhere! From a booth at the farmer’s market to an outdoor beach concert, or any kind of special event location. The only requirement is electrical power.

    Do you have the perfect spot to place an ATM in a local business, but there’s no internet nearby to connect it with? If you have a location that isn’t wired with ethernet we can help. We regularly install ATMs with wireless connections in hotel lobbies, c-stores, and many other locations, so you can put the ATM in that perfect spot, without any hassle.

    We use our own wireless network technology to connect our ATMs, using the 4G data connection from cellular networks. We can connect the ATM to all of North America and U.S. Virgin Islands with the major carriers including Verizon, AT&T, Sprint, and T-Mobile. Even if one particular mobile carrier in your area offers a spotty or unreliable cellular connection, we can switch carriers until we find the best working connection.

    Although the use of a wireless device is not required, it is definitely highly recommended so if you don't opt-in for one now, you'll still be able to get one in the future. To order one or a few separately, fill out this form or reach out to the office via email at sales@atmdepot.com.

  • Choose One:

  • Choose Your ATM Wireless Plan

  • ATM Wireless Plan Options Pricing:

    • Purchase at $139 + $9.95/month
    • Lease at $0 + $15.95/month
  • Would you like to purchase or lease your wireless device?

  • CUSTOMER INFORMATION

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • SHIPPING INFORMATION

    *Shipping charge is per device. Additional fee applies when shipping more than 1 unit. Shipping cost valid for the contiguous 48 U.S. States. Additional charges apply to HI, AK, and U.S. territories.
  • Shipping Options
  • Shipping to Billing Address?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Unlimited Transaction Use: Unlimited two way transactions apply to ATM usage with an approved processor. If at any time ATMDepot.com (Company) determines that service is used for purposes other than ATM usage, additional charges will apply and service may be terminated at the Company’s sole discretion. The Customer represents and warrants that it has the right and power to enter this Agreement and agrees to purchase or lease the equipment and subscribe to the wireless plan per the above specifications and with the following terms and conditions.

    Plans and Terms:

    1) Equipment Purchase: Equipment purchased is owned by the Customer.

    Month-to-Month (M2M) Plan: Month-to-Month plans are reoccurring and do not expire unless the Customer requests a written cancelation. M2M plans must be canceled 10 days prior to the subsequent bill date. Once a M2M plan is activated, the first month’s payment cannot be refunded.

    2) Equipment Lease: Leased units are the property of ATMDepot.com and/or a Wireless Equipment Provider of ATMDepot.com choosing.

    24 Month Contract: This agreement shall be for 24 months commencing on the date hereof. This Agreement will automatically become a M2M plan after the 24 month term. Canceling the 24 Month Contract prior to the contract end date will be assessed an Early Termination Fee. The Customer may cancel the M2M plan by providing ten (10) days written notice. To transfer your agreement within the 24 Month Contract period to another party, a separate Transfer Agreement must be filled out by both parties and submitted to the Company or the Customer is held liable for all wireless charges.

    Sales Tax Applicable for Equipment Lease Option: Sales Tax may be applicable for leased wireless units depending on the ship to address.

    24 Month Equipment Warranty: ATMDepot.com (Company) warrants new XWG-400T Models for 24 months if monthly payments are made by the Customer. The warranty is backed by the device manufacturer. Prior to submitting a warranty claim, please call our technical support team at 909-670-1988 to diagnose any service issues. If it is determined that the unit needs to be replaced, the Company at its sole discretion, will replace said Gateway with either a new or a refurbished unit. The malfunctioning unit must be returned to the Company within 10 days accompanied by the FREE return label, otherwise the purchase price of said equipment will be charged. This warranty will automatically be null and void upon termination of service or non-payment of monthly service charge. This warranty does not cover misuse or abuse, negligence of the Customer, vandalism, theft or damage including fire, water damage, and damage attributable to electric power fluctuations, obsolete or incompatible functions, or acts of God. Exclusions also include the failure to operate the Equipment in accordance with the manufacturer’s environmental and other specifications.

    Early Termination Fee (ETF): An Early Termination Fee (ETF) is charged to your account when you cancel or end your service agreement early. The ETF is charged for each canceled wireless device. ETFs do not apply to M2M plans. For leased agreements, units must be returned in good working condition (including power supply If we determine that units are in unusable condition, the customer will be assessed a fee of $100.

  • Days Remaining in Contract Early Termination Fee
    360 or more days $100
    181 to 359 days $70
    91 to 180 days $40
    90 or fewer days $25

  • Return Fee: New unused wireless units can be returned within 10 days and be assessed a restocking fee of $25.

    Reactivation Fee: Previous customers that retain a working device can submit a request to reactivate their device for a $25 fee. A new agreement and payment information will need to be submitted prior to service.

    Agreement Transfers: Contact ATMDepot.com for a transfer form. Form must be all filled out by both parties prior to submitting to the Company.

    Liability: The Company’s liability to the Customer is limited to the price paid for the equipment as per this Agreement. The Company shall not be liable for any losses, expenses or costs incurred by the Customer or others due to breakdown or malfunction of equipment, nor is it liable for the loss of any ATM transactions or ATM revenue. In any dispute between the parties, the prevailing party shall be entitled to recover from the other party all reasonable costs including, without limitation, attorney’s fees. This Agreement shall be interpreted and enforced in accordance with the laws of the State of California. The jurisdiction and venue for any legal proceeding to interpret or enforce this Agreement shall be in Los Angeles County, California. The Company has the right to assign all or any part of its rights or obligations under this Agreement at any time to any entity it chooses. The Customer shall not assign or in any way dispose of all or any part of its rights or obligations under this Agreement without prior written consent of the Company or its successors or assigns. Notices required by the terms of this Agreement shall be sent in writing by registered or certified mail, addressed to the Company and the undersigned Customer have entered this Agreement as of the date stated below.

  • PERSONAL GUARANTEE

  • Expiration Date
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  • Date of Birth
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  • Format: (000) 000-0000.

  • PERSONAL GUARANTEE: The undersigned (“Guarantor”) does hereby personally guarantee all representation, warranties, and obligations, sums due and owing hereunder to the Company under this Agreement. This guarantee shall be effective as to the initial term and to the renewal of any term of this Agreement and any claims guaranteed hereby or extensions of time of payment. In the event the Customer fails to perform in any manner with regard to this Agreement, the Guarantor do hereby promise to make all payments to the Company in the same manner as if they were the principles of this Agreement. The undersigned hereby agrees to pay all sums due and all losses or expenses which may be incurred in collecting any indebtedness of the Customer guaranteed hereunder or in enforcing this Personal Guarantee including but not limited to, attorney’s fees. Guarantor authorizes the Company to obtain consumer credit report to evaluate credit for purposes of this application. The Company shall be under no obligation to give the undersigned notice of renewal or extension of existing obligations. This Guarantee shall be binding on Guarantor and shall inure to the benefit of the Company and its successors and assigns.

  • Payment / Billing Information

    For security reasons, you will be required to text a photo copy of your credit card. See below for details.
  • Date*
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  • Date*
     / /
  • Date*
     / /

  • Please click on the "Review" button located at the bottom to see if all the information are correct then click "Submit".

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