Free ATM Request Form

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Your Name *

First

Last

E-mail Address

Phone Number

Business Address *

Years in Business?

Any ATM machines installed at your location?

• Yes
• No

Is alcohol served?

• Yes
• No

What non-cash forms of payment do you accept?

• Credit Cards
• Debit Cards
• Checks
• Money Orders
• Crypto Currency
• Gift Cards
• Mobile Wallets (eg: Apple Pay)
• Paypal
• Venmo
• Cash App
• Bank Transfers
• Other

Business Type:AirportAmusement ParkArcadeAuction HouseBarber ShopBowling AlleyBreweriesCafeteriasCampgroundsCar WashCheck Cashing StoreCoffee ShopCollege CampusConvenience StoreConvention CenterDepartment StoreDinerDry CleanersGas StationGrocery StoreHair SalonHeavy foot traffic areaHospitalHotel/MotelLaundromatLiquor StoreMallNail SalonPool HallRestaurantRV Resort ParksShopping CenterSkating RinkTicket Sales BoothTourist AreaTruck StopWrecker Company/Impound Yards

If your business type was not mentioned above, please state so here.

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