Sales, Service and Processing

Columbia, SC 29223

Toll Free 1-888-225-9184

Office 803-786-1900
Fax 803-786-5353

Requirements for setting-up a New ATM Account

Merchant

a.) ATM Service Agreement (For each location)

b.) Business License (Retail License of installed location)

c.) ACH for Direct Deposit of Surcharge if desired, otherwise a check will be sent to the mailing address

d.) W-9 for each individual or Corporation NAS sends a check or e-payment for their surcharge earnings.

ATM Owner/Operator
Note: Defined as anyone having ownership or access to the ATM.

a. Merchant Application for each applicant who has at least 50% Ownership

b.) Copy of Driver’s License

ATM Cash Provider

a.) ACH

b.) voided check or Bank Letter (Account Verification)

Fax to 803-786-5353 when finished and someone will contact you with in 24hrs to set-up an appointment to install/program your
ATM.

Any questions on filling out the paperwork please call

1-888-225-9184

Matt Harris
Chief Operations Officer
National ATM Systems
 ATM Processing Agreement
Corporate Information
Corporation Name FED TAX ID

Address

City State Zip Code

Corp Phone Corp Fax

Columbia SC 29223
TF 1-888-225-9184 Location Inforamtion
Location Name

Fax (803)-786-5353
Address
For Internal Use Only
City State Zip Code
Distributor
ATM Owner Mailing Address Corporate Location

Vault Cash Provider

Communication Owner

Processor CDS FDS Contact Information

First Name Last Name
Merch App YES NO N/A
Nick Name Ph# Cell other
Copy DL YES NO N/A
Copy Bus Lic YES NO ATM Information
ATM Type ATM Model ATM Serial #

IRS W-9 YES NO

ATM Ph # Denomination Lock Type
Vault Cash
ACH YES NO NAS
Voided Ck YES NO N/A ATM Processing Agreement
Surch ACH YES NO N/A By signing on any of the blocks below, you agree to the terms and conditions contain within this Agreement
Printed Name Signature Date
Voided Ck YES NO N/A
Dir Deposit YES NO Section II ATM Placement Agreement See Details
Printed Name Signature Date
Monthly Daily
ATM Surcharge $_________ Section III ATM Maintenance Agreement See Details
Merchant
Payment $_________ Free Labor Free Paper Free Parts
$_________ Yes NO Yes NO Yes No
Printed Name Signature Date
Maintenance $_________
Special Notes
NAS Payment $_________
Invoice Yes NO
$______________plus Tax
Internal Use Only
Off Premise Key Handicap Access Y N Camera Y N Language S F K J G
limited Hours Y Restricted
N Access Y N Talking ATM Y N MiniStatments Y N
Review By Acct Set-up Finance Tech Set-up Completion
Page 1 of 4
 TERMS OF AGREEMENT

This agreement sets forth the terms and conditions under which National ATM Systems and the
Merchant listed on the first page, will cooperate regarding their respective rights and responsibilities
under this agreement.
ATM Install/Replacement—During this agreement both parties agree the ATM may be replaced without
changing the terms of this agreement. Any ATM installed, must be approved by National ATM Systems prior
to installation for compatibility and network compliance.
ATM Location—The ATM will be placed in a suitable location agreed upon by both parties, and must comply
with ADA. The Merchant agrees not to obstruct the 4ft radius to the front and 6 inches to the left side of the
ATM from customers or maintenance personnel.
ATM Network License—National ATM Systems shall be responsible for obtaining any network licensing
pertaining to the ATM. The ATM shall accept all major network cards and provide the Merchant’s customers
with ability to perform cash withdrawals, account transfers/ balances. The services will only be limited by the
cardholder’s issuing financial institution rules and capabilities.
ATM Operator– Any person or persons qualifying as an ATM Operator ( Any person/s owning and/or having
access to the inside of the ATM) must be able pass qualifying background checks in order process ATM
Transactions. The merchant agrees to fully comply with all network and bank sponsorship rules and
regulations. The Merchant agrees to comply with all necessary paperwork as requested in a timely manner.
ATM Ownership— National ATM Systems is considered to be the owner of the ATM machine installed at the
merchant’s location, unless otherwise stated as the ATM Owner.
ATM Processing—National ATM Systems will provide ATM processing/driving for the installed ATM. The
merchant will neither contract another ATM provider/processor nor change any settings on the installed ATM
during this agreement.
ATM Surcharge—The ATM surcharge will be initially set as indicated on the front page. The ATM owner has
the right to raise or lower the surcharge to maintain profitability. The ATM owner must notify National ATM
Systems in order to change the surcharge. Changing the surcharge screen on the ATM will not in itself
change the surcharge. If National ATM Systems is the ATM owner, National ATM Systems has the right to
raise the surcharge without notification.
Communication Owner/Requirements—The communication owner agrees to provide a dedicated phone
line or internet access within 3 ft. unless otherwise agreed upon during this agreement. No other
communication device shall communicate on the same phone number or interfere with the internet access.
Damages—The merchant is responsible for any damages that result from a breach to this agreement. The
merchant agrees that any disputes will be settled in the County of Richland, South Carolina. The merchant
agrees to pay for the damages, reasonable attorney fees, and courts costs.
Force Majeure-National ATM Systems shall not be responsible for failure to deliver according to these terms
where such failure is caused by an act of god, fire, flood, strike, civil unrest, riots, war, terrorist acts, bank
liquidity problems, processor network issues, and/or failure due to an act outside of National ATM Systems
immediate control, providing National ATM Systems works to remedy the problem in a reasonable timeframe
according to the act.
Liability—National ATM Systems shall be held harmless for any and all actions, occurrences, or injuries
(intentional, unintentional, or otherwise) involving the merchant’s customers, business partners, employees,
representatives, officers, or any other party. The merchant is responsible for the installed ATM, and shall
ensure the ATM is covered under their business liability policy for the purposes of injury, fire, theft, vandalism,
or/and acts of God.
Merchant Payment—The merchant shall be paid on a (monthly or daily) basis as indicated on front page for
any valid ATM cash transaction. The United States Banking Regulation E will determine which transactions
are considered surchargeable. Account transfers and account balances are considered a non-surchargeable
transaction. If the monthly option is chosen: The merchant shall be paid by National ATM Systems by the 15 th
day after the calendar month ends. The payment will be mailed to the mailing address.
Page 2 of 4
Monthly minimum– If National ATM Systems is the ATM owner, a monthly minimum of 100 transactions
must be met before payment will be made to the merchant. Once the 100 minimum is met the merchant will
be paid for all transactions.
Network / Processor Outages– Network and processor outages may occur for maintenance downtime,
power outages, and acts of god. Both parties agree that the interruptions can and may occur and may not be
considered to be a breach of this agreement.
Power Requirements— The merchant agrees to provide 115 VAC outlet within 6 feet of the ATM during this
agreement.
Proprietary Information—The merchant shall not disclose any information concerning the number of
transactions, ATM telephone number, ATM cash delivery times, ATM terminal numbers, and encryption
codes/passwords (if known) to anyone except a National ATM Systems employee. The merchant is liable for
any damages that result as of inadvertent or otherwise disclosure such as robbery, theft, or any damages.
Proprietary Rights– Any information represented by National ATM Systems is the sole and complete
intellectual property of National ATM Systems. The merchant agrees to pay for any damages resulting from
any misrepresentation of National ATM Systems sales Information, logo, decals, or ATM signage.
Rights to ATM Transactions—During this agreement, National ATM Systems will retain the right to process
ATM transactions on the entire business location. No other ATM shall be placed on the Merchant’s property
and/or place of business during this agreement.
Signage—National ATM Systems will provide ATM / Network decals, at no charge to the merchant. National
ATM Systems, at their discretion and availability, may provide lighted signs, directional signs, and curb signs
upon the merchant’s request.
Taxes—The merchant is responsible for taxes on all income paid to them. National ATM Systems, upon
request, will send a summary of income paid. All persons requiring a Tax Form 1099 will receive this
document prior to the 31st day of January following the end of the calendar year.
Transfer of Ownership—National ATM passwords to their factory defaults for a fee of $100.00 plus mileage
and travel time.
Term—By Signing the Processing Agreement, the Merchant agrees to process with National ATM Systems
for (60) (Sixty) months. If no written termination notice is given 90 days prior to the ending date of the
agreement, the agreement will automatically and continually self renew for 60 months more after each ending
date.
Termination—National ATM Systems may terminate this agreement at anytime for profitability reasons
and/or if the monthly minimum is not met. At which time, National ATM Systems will remove the ATM without
penalty or cost to the merchant. If the Merchant requests the removal of the ATM prior to the end date of the
agreement, the merchant shall bear all costs associated with removal of the ATM and projected earnings for
the remainder of the agreement.
Web Access—The merchant has the right to gain access to a Web based program that allows the merchant
to obtain transaction information concerning the ATM under control.
Vault Cash Provider—Is responsible for ensuring sufficient cash is placed in the ATM to operate. The Cash
Provider will ensure the ATM does not run out of Cash. This can be considered a breach of this agreement if
the ATM is allowed to run empty for more than 7 days in a calendar month. The Cash Provider is liable for
any and all fees associated with reversals or incomplete transactions. Under no circumstances is the
merchant to give cash to the ATM customer for any reason. If the merchant gives the customer money for the
ATM Transaction, National ATM Systems will not be liable.

Page 3 of 4
 ATM Placement Agreement
This is considered an addendum to the processing agreement. Any changes to the ATM Agreement will not
change the terms of the ATM Processing agreement. The merchant agrees to the following:
ATM Installed—The merchant assumes all financial liability for damages to the installed ATM. The merchant
will provide replacement cost insurance for the ATM installed in the merchant’s place of business.
ATM Purchase— If National ATM Systems owns the installed ATM, the Merchant may purchase the installed
ATM or buy a new ATM after the one year anniversary of this agreement. National ATM Systems will remove
or reprogram the ATM for the merchant at no cost to them. This does not change the Processing Agreement
already enforce.
ATM Title-National ATM Systems will retain the rights to any ATM purchased from National ATM Systems
until the full purchase has been paid.
Surveillance– The Merchant agrees to maintain an Alarm system with automatic notification to the
authorities, and a video surveillance system with a recording device. The Merchant will notify National ATM
Systems when either system is inoperable.
ATM Repair Agreement
This is considered an addendum to the processing agreement. Any changes to the ATM Repair Agreement
will not change the ATM Processing agreement. The merchant agrees to the following:
ATM Repair Notification—National ATM Systems will make every effort to dispatch a technician within 24
hrs. of notification. Normally National ATM Systems will maintain sufficient levels of parts to repair the ATM at
the time of repair. If the part is not in the inventory, it can be shipped overnight at the Merchant’s expense.
National ATM Systems will pay for any standard shipping expenses when ordering parts for repair.
ATM Maintenance— The ATM Owner will be responsible for any repairs associated with the ATM machine
unless the merchant has indicated to participate in the repair agreement as indicated in this agreeement. Only
then will National ATM Systems will provide maintenance according to the terms of the ― ATM Repair
Agreement.‖
Contract Repair— National ATM Systems will provide any repairs necessary to maintain the ATM in good
working order chargeable to the ―ATM Owner‖ unless Repair Agreement is enforce. Then National ATM
Systems will repair the ATM according to the terms of the repair agreement. The merchant will not contract an
ATM repair technician for any reason due to security codes and Keys installed into the ATM. National ATM
Systems is not responsible for a 3rd party repair.
Free Labor– National ATM Systems will provide at no cost to the merchant labor to repair the ATM. A 5 hour
limit will apply.
Free Parts Limit– National ATM Systems will provide up to $500.00 in parts to repair the ATM.
Free Paper—If circled Yes, National ATM Systems will provide small misc. parts less than $15.00 total.
Otherwise the merchant will be responsible for the misc. parts.
Minor Repairs- The Merchant is responsible for minor repairs such as paper jams, bill jams, power to the
ATM outlet, the telephone line if owned by the merchant, printing journals as requested. The Merchant can
contact National ATM Systems for free Technical Support 1-888-225-9184
Not Covered-Under the maintenance agreement, National ATM Systems will not be responsible for any
network upgrades to the ATM and/or damages to the ATM caused by theft, fire, water, or any act which is not
considered normal use and/or operation of the ATM as determined by National ATM Systems.

MERCHANT Representative

Printed Name_____________________________ Date______________

Signature___________________________________________________

Page 4 of 4
 Merchant Application and ATM Operator Agreement
National ATM Systems Inc. (―ISO‖)
MetaBank (―Bank‖)
SECTION A – Application: Merchant/ATM Operator Completes Lines 1-10 ** PLEASE PRINT CLEARLY**
1. Name of Location (Doing Business As) 2. Physical Street Address of Location

3. City, State Zip 4. Location Phone Number 5. Location Fax Number

6. Business Tax ID Number 7. Financial Institution Number (FI #, FDIC, 8. Email Address of Business Principal
NCUA, ASI)

9. Type of Business (Sole Proprietor, Partnership, LLC, Corporation, Financial Institution) 10. Merchandise/Services Sold

SECTION B – Application: ATM Operator Completes Lines 11 26 ** PLEASE PRINT CLEARLY**

11A. ATM Operator Principal First Name 11B. ATM Operator Principal Last Name 12. ATM Operator Principal ―FULL‖ Legal Name (if same as 10-11, write ―Same‖)

13. ATM Operator Principal Home Street Address 14. ATM Operator Principal City, State, Zip

15. ATM Operator Principal Social Security Number 16. ATM Operator Principal Driver License Number, Issuing State and Expiration Date

17. ATM Operator Principal Date of Birth 18. Any other names by which you are now or have been known:

19. Are you on parole or probation? Yes or 20. Have you ever been convicted of a felony? 21. Percentage of Ownership held by above named ATM Operator Principal
No? Yes or No?
22. Are there any other persons/entities that own or control [10%] or more of ATM Operator? 23. If the answer to #21 is Yes, such person/entities are deemed Other Principals. Please include details
Yes or No? referenced in 10-21 regarding every Other Principal, on a separate ATM Operator Agreement.
24. APPLICATION DECLARATION: The undersigned Applicant represents that all information contained in this Application for Sponsorship, and any other documentation supplied thereto, is true and correct. The
Applicant hereby applies for an account relationship with Bank, as an ATM Operator sponsored by Bank. The undersigned acknowledges that in order to fight the funding of terrorism and money laundering
activities, Bank is required to verify the identity of each person who opens an account with Bank. Therefore, the undersigned agrees that Bank is authorized to obtain Consumer and (if applicable) Business Credit
Reports and to undertake a Criminal Background Investigation in connection with this Application. Applicant authorizes Bank or any of its agents to investigate information or data obtained from this Application. If
there is more than one Principal indicated above, Applicant hereby provides the signed authorization for such Other Principals as well. Applicant agrees to provide any further information, including financial data,
as may be reasonably requested by Bank. Applicant may, upon written request, obtain a complete and accurate disclosure of the nature and scope of the investigation requested hereunder. Applicant
acknowledges that Bank may accept or deny this Application in its reasonable discretion.

25. SIGNATURE OF ATM OPERATOR PRINCIPAL / DATE

_________________________________________________________________
Meta Payment Systems, a division of MetaBank, (―Bank‖) sponsors the ATM Terminal and financial transactions on the ATM Terminal that you financially participate in.

SECTION C – AGREEMENT BETWEEN Merchant/ATM OPERATOR, ISO AND BANK Line 26

26. In the event this Application is accepted by Bank, the above named ATM Operator, ISO and the Bank (collectively, the ―parties‖) hereby agree as follows: (1) Bank will sponsor the ATM Terminal and financial
transactions on the ATM Terminal that ATM Operator financially participates in. ATM Operator and ISO acknowledge that they have signed a separate agreement governing the placement and operation of the
ATM Terminal(s) and to abide by the terms of such separate agreement; (2) The parties agree at all times to comply with applicable laws and regulations. (3) ATM Operator and ISO agree to comply at all times
with all system and network rules, including but not limited to the Plus System, Inc., MasterCard/Cirrus, etc. Bylaws and Operating Regulations, which Bylaws and Operating Regulations may be amended from
time to time; (4) The Bank may terminate this Agreement in Bank’s sole discretion or in the event that either ATM Operator or ISO fail to comply with this Agreement and/or with the Bylaws and Operating
Regulations; (5) ATM Operator and ISO will indemnify and hold harmless the Bank, the processor, the Networks you participate in (including but not limited to Plus System, Inc., MasterCard/Cirrus, etc.) and
Network Members, from and against any and all claims, losses or damages arising out of ATM Operator’s or ISO’s failure to comply with this Agreement, with applicable laws and regulations, and with the Bylaws
and Operating Regulations. (6) the surcharge amount shall not exceed the fee defined in Section F.

SECTION D – ATM Operator Completes Lines 27-31 ** PLEASE PRINT CLEARLY**

27. Check Recipient Name (Name of person (or entity) to whom the monthly commission check 28. Mailing/Billing Address (What address should your monthly commission check be mailed to)
should be made out )

29. Corporate/Alternate Phone Number 30. Corporate/Alternate Fax Number 31. City, State, Zip

SECTION E – ATM Operator Identification (ISO Representative Completes Lines 32-35) ** PLEASE PRINT CLEARLY**
32. By signing below, I certify that the document used to identify this ATM Operator was provided to me and the above identification information is true and accurate and reflects the identity of this ATM Operator.

33. Signature of Sales Representative for ISO Typed /Printed Name Date

34. Name of Registered ISO / Sales Representative for ISO 35. Processor
National ATM Systems Inc.
SECTION F – ATM Operator Completes Lines 36- 37 (ISO Completes Lines 38- 49) ** PLEASE PRINT CLEARLY**
36. Surcharge Amount 37. Terminal Phone Number 38. Terminal Manufacturer 39. Terminal Model

40. Terminal Serial Number (# inside the ATM) 41. Terminal ID Number 42. Does this terminal have a Certified Self Encrypting 43. Encrypting PIN PAD (EPP) Serial Number
PIN PAD? Yes or No?

44. Is this terminal Triple DES compliant? Yes or 45. Is this a Scrip Terminal? Yes or No? 46. Software Version 47. Firmware Version
No?

48. Activating Custodian (1) 49. Activating Custodian (2)

SIGNATURE OF ATM OPERATOR SIGNATURE OF ISO SIGNATURE OF BANK

___________________________________ _________________________________ _________________________________

NAME: NAME Matthew Harris NAME

TITLE: TITLE TITLE
DATE: DATE DATE
This section is provided as a reference for completing the Merchant Application/ATM Operator Agreement.

BUSINESS OWNERSHIP TYPE: Please refer to question 9 in the Merchant Application/ATM Operator Agreement. Your response in that field determines
which data for your type of business you are required to provide to complete due diligence.

Financial Institution Business Name, Physical Address, FI#-FDIC-

NCUA-ASI# [Required only for financial Institutions]

Public Entity / Non-Profit/ Government Business Name, Physical Address, Tax ID# Contact Name, Telephone Number
Entity

Sole Proprietor / Partnership/ Non- Business Name, Physical Address, Tax ID# Principal Owner Full Name, Physical Home Address, Social
Public Corporation Security #, Date of Birth

Public Corporation Business Name, Physical Address, Tax ID# Contact Name, Telephone Number

Merchant/ATM Operator Information Needed

Merchant or ATM Operator Business Business Name Business dba Name Physical Complete Section A
Address (No PO Box) Type of Ownership Tax ID#
FI#-FDIC-NCUA-ASI#

ATM Operator Principal Principal Full Name Physical Address (No PO Box) Complete Section B
Social Security # Date of Birth

Merchant –If a Merchant owns the
ATM Location, the Merchant
completes Sections A, B, C and D of
the Merchant Application/ATM
Operator Agreement. Section E and F
are completed by the ISO.
ATM Operator – If an ATM Operator owns the ATM Bank – Bank refers to MetaBank, the sponsor of the ATM
placed in a location, and is also the ISO, the ATM terminal and financial transactions on the ATM terminal that
Operator must complete Sections A, B, C, D, E and may be financially participated in by a Merchant and/or ATM
F. Operator.
 PROOF OF BUSINESS

In order to comply with Association and International banking standards, it is required that Proof of Business be
provided for all businesses in possession of banking/ATM equipment.

Please attach appropriate documents below.

Attach copy of Business License or Articles of Incorporation here.

 Copy of Driver’s License

Section 326 of the USA Patriot Act (―Verification of Identification‖) directs the U.S. Treasury Department to issue regulations prescribing minimum standards
for financial institutions regarding customer identify in connection with financial equipment accounts.

Please provide the information below from you current driver’s license and make an enlarged photo copy with a legible signature.

Attach Copy of Driver’s License Here

Attachment 2

ACH AUTHORIZATION RELEASE

_____________________________ (―Customer‖) authorizes Columbus Data Services, (―CDS‖)and National ATM Systems
(―NAS‖) to initiate ACH transfer entries and to debit and/or credit the account identified herein for all Processing Services. CDS and
NAS shall have the right to credit or debit account, on behalf of the Customer, for settlement of transactions, settlement error
corrections, transaction adjustments and any amounts or fees due CDS or NAS by Customer. NAS shall have the right to debit or
deposit customer’s account for all accounts payable and receivable items. Customer agrees to keep account funded to the extent
needed to reasonably support transaction adjustments. All shortages and adjustments are the full responsibility of the Customer.
Customer agrees to comply with all electronic fund transfer regulations, requirements and rules. This Authorization shall remain in
effect unless cancelled by Customer by providing written notice of cancellation to CDS/NAS and after such time as all settlements
and adjustments have been processed/cleared through the account. Any debits and credits pursuant to this Authorization will be
effected through the Federal Reserve System automated clearing house (ACH) system.

Settlement Disputes
Customer shall audit and balance the terminal(s) associated with the settlement account indicated below and shall promptly, but in
no event more than 30 days after the date of any disputed or missing item, notify CDS of any disputed or missing item or items. If
CDS determines that the disputed or missing item was credited or debited or made in error by CDS, CDS shall correct the error;
however, CDS shall not be liable for any recovery of any amounts over 30 days prior to the date CDS was notified of the disputed or
missing item although CDS will use its best efforts to recover any amounts over 30 days from the disputed date.

The undersigned represents and warrants to CDS that (a) the person executing the Authorization is authorized signatory on the
Account referenced above and all information regarding the Account and the Account Holder is true and correct.

Authorized by: ____________________________ Date: _________________

Print Name and Title: _____________________________________________

Daily Cash Settlement Account Information***

*** This form Must be accompanied by a printed voided check or a letter from the Bank to which the funds are settling
referencing the Customer’s name, routing number and account number.

Financial Institution: _____________________________________________________

Address: _______________________________________________________________

City: _____________________________________ State: _____ Zip Code: _________

Contact Name: _____________________________ Phone Number: ______________

Routing/Transit Number (9 digits) : __ __ __ __ __ __ __ __ __

Account Number: ______________________________________

______________________________________________________
Business Name as it Appears on the Account

CDS use only

Date received: __________________
Date entered: ___________________ Entered by: ________________________________
Order for National ATM Systems to deposit cash withdrawn from your ATM into your bank account, a voided check or
bank letter is required and must be provided along with a completed ACH Authorization form. Failure to provide these
documents will delay your cash Deposit to your account

Attach Voided Check Here or a Bank Verification Letter