Merchant Application

Thank you for your interest in United Cash Solutions. Please fill out the pre-application below and a sales representative will contact you shortly. The following information is encrypted for your security.

Company Name:

Contact Name:

Mailing Address:

City:

State:

Zip:

Type of Business:

Business Phone:

Fax:

Email:

Do you currently have an ATM?
Yes
No

Have you previously had an ATM?
Yes
No

Comments or Questions?