Privately Owned ATM’s Checklist



Privately Owned ATM’s Checklist Business Name:___________________________________________________________What type of ATM is at the customer location? Please check the box that applies. It is a XYZ Bank owned ATM machine – no further action.Is the ATM contractor only leasing or renting the space within our customer’s location. 1. That would mean that our customer has nothing to do with ATM servicing. Then you will need to a get a lease agreement between the customer and ATM contractor. If the ATM is owned, operated, or serviced by our customer then the following must be provided.Please complete or obtain the appropriate document(s) needed and attach.1. Copy of the ATM agreement (purchase, sale, or lease) with their sponsoring entity.Exact location(s) of the ATM(s) _____________________________________Is the ATM currently registered as required by state law? ____________Copies of 3 recent monthly statements of ATM activity if ATM transactions are not with XYZ Bank. ? Check here if ATM account(s) are with XYZ BankCurrency Servicing ArrangementsHow is the cash being replenished? ___________________________(from store proceeds, armored car, or account withdrawals)How much and at what frequency is the cash being put into the ATM? _________________________________________________________ What is the expected daily withdrawal activity for the ATM? ___________________________________________ ___________________This form, along with supporting documentation must be sent to the Compliance/BSA Officer. ................
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