Business ATM Application Form

Business ATM Application and Services Agreement

Recitals

This Business ATM Application and Services Agreement (the Agreement) is entered into by and between Provider Name: and Merchant Name: .

WHEREAS, Provider is engaged in the business of deploying, operating and maintaining automated teller machines (ATMs) and providing related services; and

WHEREAS, Merchant operates the business premises described below and desires Provider to install and operate an ATM on the Merchant premises subject to the terms and conditions set forth in this Agreement; and

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein, the parties agree as follows:

Applicant / Merchant Information

Corporation LLC Sole Proprietorship Partnership

Site Details

Indoor/Outdoor:   Power Available: Yes   Internet Available: Yes

Scope of Work

Provider will install, operate, own and maintain the ATM equipment at the Merchant location subject to the terms herein. Services include initial installation, routine maintenance, cash replenishment coordination, connectivity provisioning, transaction processing, monthly settlement, and reporting.

Payment Terms

The parties agree the financial arrangement for ATM transactions and/or placement shall be as follows. Provider retains fees, surcharge and interchange per the pricing schedule and remits Merchant Share where applicable as set forth below.

Term and Termination

This Agreement shall commence on Start Date: and continue until End Date: unless earlier terminated in accordance with this Section. Either party may terminate this Agreement upon written notice at least Notice Period (days): days prior to the desired termination date. Provider may terminate on shorter notice if Merchant materially breaches any obligation and fails to cure within a commercially reasonable cure period.

Confidentiality

Each party shall maintain in confidence all non-public business, technical and financial information disclosed by the other party that is identified as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure. Confidential information does not include information that is or becomes publicly known through no breach of this Agreement, is rightfully received from a third party without restriction, or is independently developed. This obligation survives termination of this Agreement for a period of three (3) years.

Indemnification; Liability

Merchant shall indemnify, defend and hold harmless Provider and its affiliates from and against any claim, loss, liability, damage or expense (including reasonable attorneys' fees) arising out of Merchant's negligence, willful misconduct, or failure to perform its obligations hereunder. Provider's total liability for any claim arising under this Agreement shall not exceed the aggregate fees paid to Provider under this Agreement in the prior twelve (12) months. Neither party shall be liable for consequential, incidental, special or punitive damages except for claims arising from a party's indemnification obligations or willful misconduct.

Compliance; Access and Maintenance

Merchant agrees to maintain the site in accordance with applicable laws and local regulations and to provide Provider reasonable access for installation, maintenance and cash replenishment. Merchant will not relocate the ATM without prior written consent of Provider. Merchant shall take commercially reasonable measures to secure the ATM and premises against theft, vandalism and tampering and shall immediately notify Provider and law enforcement in the event of any security incident.

Governing Law; Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the state of Governing Law State: without regard to its conflicts of law rules. This Agreement, including any schedules and attachments executed by the parties, constitutes the entire agreement between the parties concerning its subject matter and supersedes all prior and contemporaneous agreements, proposals, or representations, whether written or oral.

Certifications and Authorization

Merchant certifies that the information provided in this Application is true and complete to the best of Merchant's knowledge. Merchant authorizes Provider to perform customary site inspections, credit and background checks on individuals designated as owners or principals, and any network connectivity verification reasonably necessary to install and operate the ATM. Merchant further authorizes Provider to disclose to Merchant the settlement statements and transaction records as required by applicable law.

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