| *1) Type of ATM Service Requested: (Please Check All That Apply) |
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| *2) Type of Location: |
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| *3) Number of Daily Visitors: |
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| *4) Number of Daily Foot Traffic in Front of Your Location: |
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| *5) Forms of Non-Cash Payment Accepted at Your Location: |
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| *6) Do you currently have any ATM Machines Installed at Your Location? |
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| *7) Are Any ATM's Available Near Your Location, Such as Banks, Convenience Stores, or Outdoor ATM's? |
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| *8) What type of ATM Machines are you considering? |
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| *9) Describe the Area Around Your Location: |
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| 10) Please provide us with any other info you feel will help us understand your business environment better, such as an ATM machine right next door, a bank ATM down the street, etc. |
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