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Operator funds provider form 2026

The document is an ATM Operator Agreement and/or ATM Source of Funds Provider Declaration Agreement between Indian River Merchant Services (IRMS) and applicants seeking to operate or provide funds for ATMs. It outlines the necessary information required from the applicant, including personal and business details, ownership percentages, and compliance with legal regulations. The agreement emphasizes the verification of identity to prevent money laundering and terrorism funding, as well as the responsibilities of both parties regarding compliance with applicable laws and operational regulations.

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Click ‘Get Form’ to open the operator funds provider form in the editor.
Begin by selecting your applicant role(s) at the top of the form. Choose between ATM Operator, ATM Source of Funds Provider, or both.
In Section A, provide the terminal deployment location details including the name, physical address, city, state, zip code, phone number, business tax ID number, type of business, and services sold.
Proceed to Section B to enter the deployed terminal information such as Terminal Identification Number and Processor details.
If you are an individual applicant, complete Section C with personal information including your name, address, social security number, date of birth, and any relevant identification details.
For company applicants and principals in Section D, fill in the company name and address along with principal ownership details for each principal listed.
Review Sections E and F for application declarations and agreements. Ensure all information is accurate before signing at the end of the document.

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