Transaction Disputes

• In what type of location do you need the ATM installed? *requiredConvenience Store/Services StationGrocery StoreAccommodationRestaurantBarHotelClub/TavernAdult VenueOther (Please specify):

• How many ATM machines do you need in total? *required12
2/9

• ATM Type *required Single Dispenser Dual Dispenser
3/9

• ATM Agreement Type *required Purchase
4/9

• If you are installing the ATM or ATMs in a business, how many consecutive years has this business been in operation? *requiredN/A - Not being installed in a business location Less than 1 year1-3 years3-5 years5+ years
5/9

• What is your desired installation time frame for this ATM machine(s)?  *requiredASAP1 to 2 monthsMore than 2 months
6/9

• What is your post code?  *required
7/9

• What is your name?  *required What is your best contact number?  *required What is your email address? (e.g. john@example.com)  *required
Why we need your email address.
8/9

• Please describe any additional details about your business or ATM needs so that our suppliers can provide you with the most accurate response. [Optional]

  Please note: There is a 1,000 character limit for this answer.

9/9

PH 0411 422 291

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