Please fill out all fields carefully and accurately. Make sure to read any instructions. SIGN UP FORM **** About Your BusinessAbout Yourself (Owner)About The ATMYour Bank Info Business Name * DBA * Business EIN Tax Number * FIRST 2 DIGITS * LAST 7 DIGITS AFTER THE DASH Company Type * C Corporation S Corporation Partnership Limited Liability Company OtherOther LLC Type Corporation S Corp. Partnership Store Name * Store Telephone Number * Store Address * Store City * Store State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Store Zip Code * Store Type * Convenience Store Bar Hotel Retail Time Zone (of store) * Eastern Central Mountain Pacific If you are human, leave this field blank. Next