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FORMS – New Location Requests
New Location Requests
Request for new TID for existing Affiliates
Name of Person Requesting
(Required)
Partner Name
(Required)
Date
(Required)
MM slash DD slash YYYY
Location Name
(Required)
Location Type
(Required)
Location Address
(Required)
City
(Required)
State
(Required)
Zip
(Required)
Location Phone Number
(Required)
Location Contact Name
(Required)
Surcharge Fee
(Required)
# of Cassetttes
(Required)
1
2
3
4
Denominations
(Required)
$1
$5
$10
$20
$100
Machine Type
(Required)
Standard 1 or 3
(Required)
1
3
Des-Keys Needed
(Required)
Yes
No
New Cash Account
(Required)
Yes
No
Name on Cash Bank Account
Routing Number
Checking Account Number
Address Associated with Account
EIN or SSN Associated with Account
Surcharge Split #1
Surcharge Account Name
Surcharge Split Amount
Last 4 of Surcharge Account
Surcharge Split #2
Surcharge Account Name
Surcharge Split Amount
Last 4 of Surcharge Account
Surcharge Split #3
Surcharge Account Name
Surcharge Split Amount
Last 4 of Surcharge Account
Cash Account Owner
Last 4 of Cash Account
Surcharge Split #1
Surcharge Split Amount
Surcharge Account Name
Last 4 of Surcharge Account
Surcharge Split #2
Surcharge Split Amount
Surcharge Account Name
Last 4 of Surcharge Account
Surcharge Split #3
Surcharge Split Amount
Surcharge Account Name
Last 4 of Surcharge Account
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SOLUTIONS
ATM Solutions
ATM Sales
ATM Placements
Turnkey ATM’s
Cash Management
SHOP ATMS
ATMs
Wraps
Surrounds
SUPPORT
Contact Us
Email
Phone
Error Code Help
LOGIN
Client Login
NCS Login
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CONTACT US
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888-642-2274
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