The Internet's #1 site for Surplus ATM (Automated Teller Machine) Banking Equipment Sales

To: Sales Purchasing Management

From:

Organization Name:

Address Line 1:

Address Line 2:

City :

State: Choose a State Outside US / Canada 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

Country: Algeria American Samoa Antarctica Argentina Armenia Aruba Australia Austria Bahama Bangladesh Barbados Belgium Belize Bermuda Bolivia Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Côte D'ivoire (Ivory Coast) Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Monserrat Morocco Mozambique Myanmar Nambia Nauru Nepal Netherlands Antilles Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (Great Britain) United States Minor Outlying Islands United States of America United States Virgin Islands Unknown or unspecified country Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

Zip / Postal Code:

Telephone: Extension:

Fax:

E-mail Address:

Buy: Sell: Other:

Interest: NCR: Diebold / InterBold: Other:

If NCR: Please Select Family SelfServ PersonaS 58XX Series Don't Know Type: Please Select Type Drive-Up ATM Walk-Up ATM Lobby ATM Cash Dispenser Don't Know

If Diebold: Please Select Family Opteva ix Series Don't Know Type: Please Select Type Drive-Up ATM Walk-Up ATM Lobby ATM Cash Dispenser Don't Know

If Other: Manufacturer:

Other Type:

Comments:

Please Select The Send Button To Transmit:

Or Reset Form and: Return to top of form

Thank You for taking the time to prepare this form. Your request will be answered in as prompt manner possible.
Should you desire to contact us by telephone, our direct line is (276) 466-2929.
Thank You again !