TECH ONSITE FORM
Installer Name:
*
First Name
Last Name
Email
*
example@example.com
Referring Partner:
*
ATM:
*
Add - If it's a new machine install, select "Add"
Remove - If the machine's being removed from location, select "Remove"
Update - If this is an existing location and you are updating current machine info (photos, hours, etc.), select "Update"
Other
Location Name:
*
"PLEASE DO NOT USE CORPORATE NAME!"
External ID:
*
Type of Location
*
Gas Station
Liquor Store
Convienace Store
Restaurant / Bar
Laundromat
Other
Gas Station Brand
Number of Gas Pumps
Please Select
1-4
4-8
8 - 12
12+
Model Name:
*
Please Select
Select Model
Satoshi1
Satoshi2
Finney3
Satoshi Edge
Gemini
Equipment Serial #:
*
This is located on the sticker inside the machine.
Wireless Serial # or Connection Type
*
Place Wireless SN # above, if using Wifi or Ethernet Fill in accordingly
Lock Serial #:
Look for A KABA Sticker SN Starts with 001
External Lock?
*
Yes
No
Machine bolted down?
*
Yes
No
Is it Handicap Accessible?
*
Yes
No
Is it Well Lit?
*
Yes
No
Is there a Public Restroom?
*
Yes
No
Is there EV Chargers Available?
*
Yes
No
Is there a Restaurant Inside location?
*
Yes
No
What's the Resturants Name
Number of Parking Spots
Please Select
1-5
5-10
10+
Plaza Parking Lot
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Picture of lock + Lock Sticker
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
(1 Storefront Image) + (2 Bitcoin ATM Images)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Machine Serial Number Sticker
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Hours: 24/7?
Yes
No
Hours:
*
Sunday:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Sat:
About the Area
What is around the location Ex: What's across the street, what's it next to, any attractions near by?
Comments:
Install Date:
-
Month
-
Day
Year
Date
Submit
Should be Empty: