Fifth Third Bank Portable ATM Request Form

This form must be completed and submitted 45 days before the requested event.

Site Requirements Site Recommendations Contact Information

 

NOTE: All fields marked bold are REQUIRED

REQUESTS MUST BE FILLED OUT EVERY YEAR FOR AN ATM
EVENTS WILL NOT BE AUTOMATICALLY SCHEDULED IF YOU HAD AN ATM THE PREVIOUS YEAR

A $4.00 surcharge fee will apply for any ATM transactions which are performed by customers who do not use a Fifth Third Bank account

 ATM Request 
Portable ATM (click here to view sample)     Number of Portable ATMs Requested  
  Delivery Date*   Time
  Return Date*   Time
 
 Event 
Name*
Address
City   State   Zip
Event Contact   Contact Phone ( )   Contact Fax ( )
Email Address*
Emergency Contact Name   Number ()
 
 Event Details 
Date   From   To
ATM Operation Times Special Instructions
  On Off
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
 FIFTH THIRD CONTACTS 
Name of Authorizing Fifth Third Bank Vice President
**** All Portable ATM requests must be approved by a Fifth Third Bank Vice President
 

This Agreement is entered into this day of , 2017, and is by and between FIFTH THIRD BANK ("Fifth Third"), an Ohio banking corporation, and ("Company / Organization").

WHEREAS, Company wishes to have a Fifth Third Portable automated teller machine ("ATM") on their property located at , (the "property") for the period from , 2017 to , 2017.

WHEREAS, Fifth Third desires to place the ATM on the property.

NOW THEREFORE, in consideration of the foregoing, the parties agree as follows:

1. Company / Organization agrees during the period of time the ATM is on the property to:

  1. Furnish electrical power and maintain appropriate environmental conditions for the operation of said ATM and its appurtenances;
  2. Permit Fifth Third, its agents, servants and employees access to said ATM and/or related Company / Organization property during hours of operation for the purposes of installation, maintenance, and servicing of said ATM or at such designated pre-opening or post-closing hours as mutually agreed;
  3. Provide normal cleaning around the ATM;
  4. Maintain the area around each ATM in orderly fashion so that customers have convenient and safe access to the ATM;
  5. Provide appropriate security, including customer security precautions and lighting, consistent with any normal operating standards of Lessor, and
  6. Indemnify and hold Fifth Third harmless for any damage to the ATM arising out of or attributed to or in connection with conditions and operations which are in company's control, including but not limited to damage from inclement weather and vandalism.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date set forth above.

FIFTH THIRD BANK
By:  Mark Nowlin
Its:  Vice President

(Company / Organization)
By:
Its:
By typing your name in this
form, you are agreeing to
the terms and conditions.