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.