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New Agent Application

Confidential

Bitcoin Kiosk Application

Thank you for your interest in partnering with InstaBit. In order to complete the application process, please complete and attach the required documents below. After extensive review, a InstaBit representative will contact you to discuss moving forward with the on-boarding process.

Company Information

Business Operations

Owner Information

Legal Agreement

The applicant(s) represent(s) that all statements contained in this form and in the other documentation submitted in support of this application are true and correct. Permission and authorization is hereby granted by the applicant to InstaBit LLC and/or its designee or third party vendor assigned by InstaBit LLC, consumer credit services, and to state and federal government agencies or representatives, to verify, receive, exchange, and obtain business and/or personal credit and other information as part of this application or at any time thereafter in connection with the ongoing application evaluation, providing of software services, software licensing, review of money services business activities and/or compliance or collection related actions. The undersigned further agrees to hold harmless any individual or business entity who does furnish, or has furnished, any information to InstaBit LLC, directly or indirectly, concerning the applicant, its business and/or the undersigned, from any losses or damages, and/or any claim resulting from any verification, receipt, exchange, or obtaining business and/or personal credit or other business and/or personal information. The person(s) signing this application further represents that s/he is authorized to make the above representations, waiver of claims and authorizations, and if applicable, is an authorized representative of any business entity making this application.