The new purchase questionnaire will provide the most expeditious method of completing the required ATM paperwork necessary to get your ATM setup in the bank processing network. Once the questionnaire is completed your answers will automatically generate the completed paperwork to be submitted. You MUST answer all of the questions or the paperwork will be denied.

Note: due to the processing admin time required to setup all new terminals a one-time $35.00 setup fee will be deducted from your ATM cash replenishment account

* NOTE: Your application will most likely be denied if any of the following conditions exist:

• Bankruptcy within past 7 years
• Credit score of 550 or below
• Outstanding judgements or liens
• Felony conviction(s)
• Cannot provide valid social security number

If any of these apply to you, please have a partner or spouse fill out the questionnaire. If there is not anyone to do this for you, please contact your Convenience ATMs sales representative for other options.