Internal to send ATM HQ Purchase with Equipment documents

My Products

Genmega G2500This ATM is the base model from Genmega. However, it is considered a premium ATM machine in the retail ATM market due to its reliability and features. It has all the features you would expect, and has options for additional cash cassettes (multi-denominations), a larger LCD screen, wide width printer, level 1 ultra secure safe, and various lighted toppers).

$2,395.00 Quantity

Genmega ONYXStep up from the base model Genemga 2500 ATM to the Genmega Onyx ATM. This ATM has all the features from the GenMega 2500 ATM, but adds a large touch screen display , an front mirror lined facia, and elegant black front facia and machine paint scheme. Options for additional cash cassettes (multi-denominations), ultra large LCD screen, wide width printer, level 1 ultra secure safe, and various lighted toppers are also available.

$2,545.00 Quantity
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Nautilus Hyosung FORCEThe Nautilus Hyosung Force ATM features a 12.1 inch color display, touch function keys, and many other enhanced modern features that provide an excellent user experience with reliable performance.

$2,749.00 Quantity

Nautilus Hyosung HALO IINew from Nautilus Hyosung, the Halo II provides the best value of any retail cash dispenser in the industry with added peace-of-mind from enhanced security features at an affordable price.

$2,495.00 Quantity

Cash Capacity Cassette Selection Product Image

Cash Capacity Cassette SelectionPlease choose from the following selections for the size and amount of cash bills your unit will dispense. Standard configuration is 1K Single cassette.

$ Free
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ATM Modem SelectionStandard Wired Network connection included at no additional cost. Selecting a cellular modem will remove the need for network cabling and connection to your network. Cellular modems work with a cellular plan like your cell phone. They increase uptime by enabling network diagnostics and remote service actions. If selected, the cellular units will incur a cellular modem unlimited data plan at a cost of $15.00 a month deducted from your processing surcharge payment in addition to the cost of the modem.

$ Free
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Shipping MethodStandard Setup, Delivery and installation is included with all ATM purchases for Customers using ATM Headquarters for ATM Processing. ONLY Select shipping option if you WILL NOT be using us for your processing and have another processor who will be adding this equipment to an agreement.

$ Free
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Show Discount$75.00 Off

$75.00 Quantity

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Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Confirmation of ATM Processing with ATM HEADQUARTERS LLC. (ATM Headquarters offers FREE Processing to all of our customers that includes programming, reporting and technical support).*

I WILL be using ATM Headquarters for ATM Transaction ProcessingI WILL NOT be using ATM Headquarters LLC for ATM Transaction processing.

Business name or DBA for your business (Name on the Door of the business)*

Physical Street Address of Location where the ATM is being installed*

City, State, Zip of Location*

Location Contact Person

Location Phone Number

Please enter a valid phone number.

What does your Business do? (Convenience Store, Bar, Hotel, Hair Salon etc.)

Legal Name of Company or Person *

Mailing Address of Company or Person*

City, State, Zip*

Check appropriate box for federal tax classification of the person or company whose name is listed above. Check only one of the following seven boxes.*

Individual/sole proprietor or single-member LLCC CorporationS CorporationTrust/estatePartnershipLimited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Limited liability company. Enter the letter here for the tax classification of your LLC: (C=C corporation, S=S corporation, P=Partnership)

Confirm the above selection by choosing the same field as selected above

Enter your Employee Identification Number (EIN)

Enter your Social security number

The Person who is legally Authorized by the Business to execute and authorize these documents and agreements and is signing these documents.

Title of the Person named above (Example: Priciple, Owner, President, CEO, Etc..)

Authorized Representative Direct Phone Number

Please enter a valid phone number.

The Legal Name of Company as stated on documents of incorporation filing OR the Person name if a Sole Proprietor or Single Person LLC that you wish to list for tax filing purposes. *

Check appropriate box for federal tax classification of the person or company whose name is listed above. Check only one of the following seven boxes.*

Individual/sole proprietor or single-member LLCC CorporationS CorporationTrust/estatePartnershipLimited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Limited liability company. Enter the letter here for the tax classification of your LLC: (C=C corporation, S=S corporation, P=Partnership)

Mailing Address for tax documents

City, State, Zip of Location

Enter your Employee Identification Number (EIN)

Enter your Social security number

Who is providing the operating cash for the ATM?*

ATM Headquarters will be providing the Cash and loading the ATM. (ATM Headquarters will quickly follow up and contact you with our rates for cash loading services and will amend your agreement to include those terms)A Business with an EIN or FEIN Number.A Person or Sole Proprietor LLC with a Social security Number.

Name

First NameLast Name

Social Security Number

Home Address

Persons Physical Street Address

Street Address Line 2

Persons City, State, Zip

Date of Birth (mm/dd/yyyy)

Date

Persons Direct Contact Number

Please enter a valid phone number.

The Legal Name of Company as stated on documents of incorporation filing where the funds used to operate the ATM will come from.

Company Federal Employer Identification Number (FEIN)

Corporate Mailing Address

Company Address

Street Address Line 2

Company City, State, Zip

Do you want your Daily operating cash replacement and your monthly surcharge payments deposited into the same account?*

Yes, deposit into the same bank accountNo, I would like my monthly surcharge payment to be deposited into a different bank account as listed below.No, I would like to receive my monthly Surcharge payment manually mailed in a check. (NOTE: This option will incur a Monthly processing fee of $20.00) I acknowledge this fee by selecting this option)

Bank Name*

Bank Branch Address - if available

Bank Branch City

Bank Branch State

Zip

Account Type*

CheckingSavings

Name on the bank account (This name must match bank account records for this account)*

Bank Routing Number*

Bank Account Number*

Create a User Name for your report access

Enter an Email to use for this user name

example@example.com

Bank Name

Bank Branch Address - if available

Bank Branch City

Bank Branch State

Zip

Name on the bank account (This name must match bank account records for this account)

Account Type

CheckingSavings

Bank Routing Number

Bank Account Number

Thank you for taking the time to correctly complete this information. Please sign below to complete and press Continue to get your machine ordered, set up and ready for delivery! You will recieve a complete copy of all documents sent to the email specified below.

Signature*

Printed Name of Person Signing above*

Title of Person Signing Above: Example: Principle, President, Owner, etc.*

E Mail for Authorized Signer

example@example.com

Date

Thank You for choosing ATM Headquarters for your ATM Needs!

Now that you have selected your equipment, We need your information to set up your account to GET YOU PAID!

ATM Location Corporate Organization and Authorized Persons Information

Corporate information

Tax Information For W-9

Source of Funds Provider (SOFP) Who will be filling the ATM with the operating cash?

Person providing operating cash is an Individual or a Sole Proprietor. This can be the same as information above or a different Company or Person. Please complete the information below even if it is the same as above.

Bank Deposit Information to ensure your cash replenishment and / or surcharge payments are deposited correctly.

Would you like access to Reports for your Processing?

Second Bank Deposit Information if you wish for your Monthly Surcharge Payment deposited into a different account.