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ONLINE FORM MUST BE COMPLETED IN ORDER TO OBTAIN THE REBATE
 
Please send my rebate of $500 to:(All fields* are required)
*Name of FI:
*Address:
*City:
*State:
*Zip:
*Contact name:
*Phone:
*Email:
*Authorized Triton Distributor::
*FT7000 Serial Number:
 
Please fill out your tax address if different than the ATM location:
Tax Address:
Tax City:
Tax State:
Tax Zip:
 
*Tax ID:
 
Tell us a little about your FI: (All of these fields are optional)
Number of Branch Locations:
Do you have plans to build or acquire new branches in the next 12-24 months? Yes  No
Number of through-the-wall ATMs owned or operated by your FI:
How many of them are Triton ATMs:
Do you own or operate ATMs at off-site locations? Yes  No
If yes, how many off-site locations do you operate?
How many of them are Triton ATMs?
 
Are you a member of any professional organizations? (check all that apply)
ABA  ICBA  CUNA  NAFCU  CUES   Other 
 
I would like to receive more information on this type of product from Triton: Yes  No
 
You must attach a copy of your purchase order: (Max. size 500k)
  Fax: (228) 868-0437
Mailing Address: 522 E. Railroad St. Long Beach, MS 39560
Attention: Marketing