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Section 1 - ATM Placement Details and Business Preferences:
Reason you want an ATM:
Do you accept Credit Cards? If not, will you after the ATM is Installed?
Number of Barbers/Stylists/Artists (if applicable)
Average Number of Daily Customers:
Section 2 – Revenue Split (Make a selection)
Variable: $3.50 Surcharge Per Transaction:
Make a Selection
0-30 Transactions: $0.15
30-100 Transactions: $0.50
101-250 Transactions: $1.00
251+: $1.10 Per Transaction Paid to Location
*Must Setup ACH to receive Variable
Flat Rate:
Make a Selection
$2.99 Surcharge = $0.40 Per Transaction Paid to Location
$3.25 Surcharge = $0.60 Per Transaction Paid to Location
$3.50 Surcharge = $0.75 Per Transaction Paid to Location
$3.75 Surcharge = $1.00 Per Transaction Paid to Location
Section 3 - Rolly Receipts Free ATM Service Agreement Summary
1) Free ATM. No Cost or Liability to the location. Rolly Receipts provides, installs, and maintains the ATM for Free.
2) Revenue Sharing to the Location as selected above. Automatically earned with our Direct Deposit ACH payouts.
Rolly Receipts LLC is a Nationwide ATM operator located at 205 S Walnut St, Arcanum, OH, 45304. By signing below, the Business (“The Location”) acknowledges that they have read, understood, and expressly agree to all terms and conditions outlined in the Rolly Receipts Master ATM Agreement available at
https://rollyreceipts.com/atm-terms.
The foregoing Agreement & Obligations are personally guaranteed by the undersigned, jointly and severally. This Master Agreement is fully incorporated into this Free ATM Form by reference and constitutes a binding contractual obligation.
I Agree to Terms
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View Free ATM Fillable Form (pdf)
Email to
Sales@RollyReceipts.com
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