ConnectATM - New ATM/Terminal Installation Sheet

1

What is your Full Name?As your name appears on legal documents!

First Name

Last Name

2

What is your cell phone number please?We will need this to get a hold of you for important reasons. We do not sell your information.

Area Code

Phone Number

3

What is your email address?This will be the email address that you want to associate with your new ATM machine

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

4

What is the Business Name?This is the name of the business where this ATM machine is being installed.

5

What is the full address of this Business?This is the address of where the ATM machine is being installed.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

6

What is the business phone number?This is the actual phone number of the place of business. Not the cell phone of the owner or manager.

Area Code

Phone Number

7

What is the Full Name for the main contact at this business?We need to name so that we have a secondary person to call for this installation.

First Name

Last Name

8

What is their Email Address?We need this just in case we have trouble contacting someone.

example@example.com

9

What is the Main Contact cell phone number?We use this for emergency contact situations only.

Area Code

Phone Number

10

Has the new ATM been delivered?We will not schedule an ATM installation the same day of delivery. No exceptions unless approved by the installer and ConnectATM

YESNO

11

If the new ATM has not arrived yet, when will it be delivered?We usually like to add one whole day after delivery to schedule an install.

Date

12

How much do you want to charge for a ATM Surcharge?FYI. There is no need to be the cheapest ATM surcharge in your neighborhood. Walk around, do some research and be the same price as all other ATMs in your area. Studies show that an ATM user will not walk across the street for a surcharge that is cheaper. They want the money now and will always adjust their withdrawal amount in relation to their "feeling" of the surcharge amount.

13

How will this new ATM be connected to the internet?WiFi connection from your internet router is not allowed!

Phone Cord using the Phone Modem

Ethernet Cable coming from the internet modem (Cable, DSL, Fiber modems)

3G/4G modem (must be purchased separately)

14

Are you aware that the "installer" will not run cables to connect your ATM?In most states this is not allowed as per regulation.

YESNO

15

Do you need cables run to the new ATM location?This will be an extra cost.

YESNO

16

What type of floor is the new ATM being bolted too?

Concrete Floor

Tile Floor

Wood Floor

Other

17

Is there carpet on the floor?

YESNO

18

Is the area around the new ATM location clear of obstacles and fixtures like shelving, appliances, etc?

YESNO

19

If not, will it be clear before the "installer" arrives?The space needs to be cleared out beforehand.

YESNO

20

Is there an electrical power receptacle near the new ATM location?There needs to be one close by.

YESNO

21

Is the internet connection nearby?It needs to be because most states do you not allow an ATM installer to run cables of any type.

YESNO

22

Do you already have another ATM that has a previously created processing account?We will try our best to accommodate a request to build your new ATM/Terminal with your current processor.

YESNO

23

If Yes, what is the name of your current processor?

24

Please sign here!

Clear

25

Name of person signing this document!Just because we'd like to know. Information is power! LOL!

Prefix

First Name

Middle Name

Last Name

Suffix

26

Date of signing!

Date

27

ConnectATM - Primary Contact!