Step 1 of 7 - New Order Configuration
Application Declaration:
The undersigned applicant represents that all information contained in this Application for Sponsorship, at any other documentation supplied thereto, is true and correct. The Applicant hereby applies for an account relationship with Bank, as an ATM Operator and/or ATM Source of Funds Provider sponsored by Bank. The undersigned acknowledges that in order to fight the funding of terrorism and money laundering activities. The Bank is required to verify the identity of each person who opens an account with Bank. Therefore, the undersigned agrees that Bank is authorized to obtain Consumer and (if applicable) Business Credit Reports and to undertake a Criminal Background Investigation in connection with this Application. The Applicant is a company, Applicant hereby provides the signed authorization for such Company. Applicant agrees to provide any further information, including financial data, as may be reasonably requested by Bank. The Applicant may, upon written request, obtain a complete and accurate disclosure of the nature and scope of the investigation requested hereunder. Applicant acknowledges that Bank may accept or deny this Application in its reasonable discretion. Meta Payment Systems, a division of MetaBank ("Bank") sponsors the ATM Terminal and financial transactions on the ATM Terminal that you financially participate in.
In the event this Application is accepted by Bank, the named ATM Operator/ATM Source of Funds Provider, ISO and Bank (collectively, the "Parties") hereby agree as follows:
(“Customer”) authorizes Columbus Data Services, (“CDS”) to initiate ACH transfer entries and to debit and/or credit the account identified herein for all Processing Services. CDS shall have the right to credit or debit account, on behalf of the Customer, for settlement of transactions, settlement error corrections, transaction adjustments and any amounts or fees due CDS by Customer. Customer agrees to keep account funded to the extent needed to reasonably support transaction adjustments. All shortages and adjustments are the full responsibility of the Customer. Customer agrees to comply with all electronic fund transfer regulations, requirements, and rules. This Authorization shall remain in effect unless canceled by Customer by providing written notice of cancellation to CDS and after such time as all settlements and adjustments have been processed/cleared through the account. Any debits and credits pursuant to this Authorization will be effected through the Federal Reserve System automated clearing house (ACH) system.
Settlement Disputes
Customer shall audit and balance the data contained in the periodic statements and reports provided by CDS and shall promptly but in no event more than 30 days after the date of the disputed item, notify CDS in writing (the “Notice Date”) of any disputed item or items on such periodic statements and reports. If CDS determines that the disputed item was credited or debited in error by CDS, CDS shall correct the error. Notwithstanding, CDS shall not be liable for any recovery, reimbursement or otherwise of any amounts over 30 days from the Notice Date. CDS will, however, use its commercially reasonable efforts to recover any amounts over such 30-day period. CDS shall not be liable for any damages, interest or costs associated with the error other than correcting the error.
The undersigned represents and warrants to CDS that the person executing the Authorization is an authorized signatory on the Account referenced below and all information regarding the Account and the Account Holder is true and correct.
As the credit card holder, I also authorize Empire ATM Group to charge my credit card for future purchases verbally (or written) approved by me.
Your completion of this authorization form helps us to protect you, our valued customers, from credit card fraud. Empire ATM Group will keep all information entered on this form strictly confidential.
The customer identified above, hereby authorizes Empire ATM Group and it's financial institution, to initiate and/or transmit monthly service fee debits for the wireless device via automatic clearing house (ACH) from the customer's account. The parties a free and understand that this ACH authorization is for multiple debit entries (Service will conclude upon the return of wireless box to Empire ATM Group). Customer acknowledges that the purpose of this ACH release is for the payment to Empire ATM Group for multiple provisions of goods or services from Empire ATM Group to the customer and that this constitutes a valid business relationship between the two parties. The customer agrees to indemnify and hold Empire ATM Group and/or customer's financial institution harmless from any and all claims associated with compliance with the aforementioned multiple use ACH authority. The customer agrees to provide a voided check to properly validate customer's account and routing numbers.
ALL PRODUCTS PURCHASED THROUGH EMPIRE ATM GROUP ARE FOR ATM USE ONLY. ANY UNIT DEEMED TO BE ABOVE AVERAGE ATM DATA USAGE WILL BE SUSPENDED IMMEDIATELY, AND MAY BE SUBJECT TO A REACTIVATION FEE.
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