GPSS ATM Placement Coordination Agreement
REVIEW TEMPLATE - UNSIGNED

1. Parties and limited coordination scope

This is a GPSS coordination template for review and completion. It is not a North-issued ATM, processing, financing, vault-cash or settlement contract. North and any actual equipment, cash or service provider must independently approve the location and enter their own required agreements. GPSS may coordinate the introduction, site review and follow-up only within its accepted authority.

GPSS legal contracting name: ______________________________

Host legal name / authorized signer: ______________________________

Site address: ______________________________

North program / representative: ______________________________

Actual equipment owner / installer: ______________________________

Actual service provider: ______________________________

Proposed equipment reference: ______________________________

GPSS associate / referral reference: ______________________________

2. Conditions before installation

Obtain written provider approval, host/landlord permission, site survey, full fee schedule, approved equipment and an accepted service plan. Confirm accessible placement, safe anchoring, power and approved connectivity. No free ATM, approval, transaction volume, earnings or installation date is guaranteed by an inquiry or this unsigned template.

Provider agreement references / dates: ______________________________

Host / landlord permission reference: ______________________________

Site survey / approved placement: ______________________________

Target date subject to approval: ______________________________

3. Responsibility and financial boundaries

Identify the responsible party for each function below. Do not enter account numbers, passwords, PINs, cash quantities or replenishment schedules in this packet or a public form. Use the provider-approved secure channel for those details. Host and GPSS must not independently load cash, open equipment or alter security controls unless specifically authorized under the applicable provider agreement.

Equipment / installation responsibility: ______________________________

Cash loading party (name only): ______________________________

Connectivity / utility responsibility: ______________________________

Processing / settlement provider: ______________________________

Fees and host compensation reference: ______________________________

GPSS compensation agreement reference: ______________________________

Repair / support / refund contact: ______________________________

Insurance / security requirements reference: ______________________________

4. Provider terms, service and exit

Provider agreements govern provider equipment, transactions, settlement, cash services, network requirements, fees and provider support. This coordination document cannot amend or bind North or an unsigned third party. Attach the accepted maintenance schedule only where the responsible provider signs or accepts it. Suspend installation if material responsibilities conflict or remain unassigned. Record change approval, termination/removal process and final reconciliation in the applicable agreements.

Service schedule / acceptance reference: ______________________________

Coordination fee / payer or NONE: ______________________________

Coordination cancellation / notice terms: ______________________________

Host signer / title / date: ______________________________

GPSS signer / title / date: ______________________________

Provider acknowledgement reference: ______________________________

Complete all blanks and obtain qualified review before use. Provider acknowledgement is not implied. GPSS has not executed this document; the website does not collect binding electronic signatures.