[RENTAL ePort] Greenlite Signup Form for ePort RENTAL SIGN UP ONLY Header Image

[RENTAL ePort] Greenlite Signup Form for ePort RENTAL SIGN UP ONLY!

We offer 2 plans, one basic and one advanced for future-proofing your business...

 

GREENLITE BASIC: Basic Cashless Plan with limited reporting and features

GREENLITE DATA: Signature **Greenlite Data** Plan with enhanced reporting and advanced business management -- Includes: Real-time Texts or Email Notifications, Quickpicks and more....

  

Questions? Contact us or call 515-271-5450

 

The Greenlite system can be used on most MDB equipped machines. Depending on the machine make and model there may be additional parts needed in order to hook up the system.  

 

Tech support on Greenlite card readers and support are provided by Vendnet, a Wittern Group company.  We are available 8-5:30 Monday thru Friday CST.  All support is provided from our offices in Des Moines Iowa. Questions? Contact us.

 

1. My Business Info

Note: We need your business name, not location.
Billing Address (if you are provide a P.O Box, you must also include a shipping address (click "ship devices to a different address below)*

2. My Shipping Info

Name
Address

3. My Contact Info

4. My Bank Deposit Info

In order for Cantaloupe to pay you, we must have your routing number and account number tied to your primary checking account. DISCLAIMER: Please do not use a savings account.

Name on Account (If a BUSINESS NAME, write the BUSINESS NAME in both the *first* and *last* name box)*
Please note that the monthly draft will come from company: "Cantaloupe Syste ePay"
Bank Address*

4. BILLING ACCOUNT VALIDATION (VOIDED CHECK OR OTHER)

TO ENSURE YOU RECEIVE PAYOUTS CORRECTLY, PLEASE ATTACH A VOIDED CHECK (OR OTHER PROOF OF BOTH *ACCOUNT* & *ROUTING* NUMBER). NOTE: DEPOSIT SLIPS DO NOT QUALIFY FOR ACCOUNT VERIFICATION) THANK YOU!*
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5. ACH Recurring Payment Authorization

Schedule your payment to be automatically deducted from your business checking or savings account. Just complete and sign this form to get started!

Here’s How Recurring Payments Work: You authorize regularly scheduled charges to your business checking or savings account. You will be charged the amount indicated below each billing period. A receipt for each payment will be emailed to you and the charge will appear on your bank statement as an “ACH Debit.” You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

Please complete the information below:

Transaction and service fees will be deducted from the flow of funds before EFT payment is issued. On the agreed upon day of your weekly EFT payment, your account must have a net balance of $25.00 or more to receive an EFT, otherwise, all funds roll over into the next weekly EFT pay period and continuing until at which time your account has a net balance of $25.00 or greater.

Direct Credit Authorization:

You hereby authorize Cantaloupe, Inc. and its designated financial agents to initiate an ACH debit (automatic withdrawal) entry to the account listed above for payment of monthly network service fees and other fees agreed to in your License Agreement, and to debit the entry to the company's account (as listed above). This authorization is to remain in full force and effect until Cantaloupe, Inc. receives notification from an official or authorized agent of your company of the termination. To revoke this payment authorization, you must contact Cantaloupe, Inc. at (610) 989-0340 no later than 2 business days prior to the payment (settlement) date. You also authorize Cantaloupe, Inc. and the financial institutions involved in the processing of the electronic payment of fees and charges to receive confidential information necessary to answer inquiries and resolve issues related to the payment. On the agreed upon day of your weekly EFT payment, your account must have a net balance of $25.00 or more to receive an EFT, otherwise, all funds roll over into the next weekly EFT pay period and continuing until at which time your account has a net balance of $25.00 or greater.

You hereby authorize Cantaloupe, Inc. and its designated financial agents to initiate credit entries to the account listed above in connection with agreed upon Electronic Data Interchange (EDI) transactions between our companies. You agree that such transactions will be governed by the National Automated Clearing House Association (ACH) rules. This authority is to remain in effect until Cantaloupe, Inc. has received written notification of termination in such time and such manner as to afford Cantaloupe, Inc. a reasonable opportunity to act on it. You also authorize the Bank listed above to verify your account information as necessary to establish the EFT. In no event shall Cantaloupe, Inc. be liable for any special, incidental, exemplary or consequential damages, or any in excess of the amount of the error as a result of the daily, omission or error of an electronic credit entry, even if Cantaloupe, Inc. has been advised of the possibility of such damages. This agreement shall be governed by the laws of the State of Pennsylvania.

Date*
In the event that Cantaloupe withdraws erroneously from the undersigned’s account, the undersigned authorizes Cantaloupe to credit the undersigned’s account for the amount erroneously withdrawn.

Billing Address*
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Date*
By signing this Authorization, the above named entity (“Customer”) understands that this authorization will remain in effect until Customer cancels it in writing, and Customer agrees to notify Cantaloupe in writing of any changes in its account information or termination of this authorization at least 30 days prior to the next billing date.  Customer understands that because this is an electronic transaction, these funds may be withdrawn from its account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) Customer understands that Cantaloupe may at its discretion attempt to process the charge again within 30 days, and agrees to an additional $50 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. Customer acknowledges that the origination of ACH transactions to its account must comply with the provisions of U.S. law.  Customer agrees not to dispute this recurring billing with its bank so long as the transactions correspond to the terms indicated in this authorization form.

6. Authorization to Assume Merchant of Record Status for Transactions


By its signature below, the undersigned Customer hereby appoints and authorizes Cantaloupe Systems, Inc. or its designee successor or assign (hereinafter “Cantaloupe”) to assume the status of “Merchant of Record” on the “MoR Transition Date” (as defined below) for all sale transactions consummated on Customer’s vending machines equipped with Cantaloupe’s Greenlite Cashless devices. In connection with such appointment as Merchant of Record for Customer’s cashless sales transactions, Customer acknowledges and agrees that Cantaloupe shall be entitled to notify Customer’s credit card processor (“Processor”) that Cantaloupe has been appointed and assumed the role of Merchant of Record and that Processor shall thereafter remit all collected funds directly to Cantaloupe on account of cashless sale transactions at Customer’s machine locations. The delivery of an executed copy of this Authorization to Assume Merchant of Record Status for Transactions (“Authorization”) shall constitute sufficient evidence of such appointment and Processor shall be entitled to rely solely on this document as proof that such appointment has been duly authorized and acknowledged by Customer without the necessity of further documentation or investigation.


In connection with the appointment of Cantaloupe as Merchant of Record, Customer hereby agrees and acknowledges that Cantaloupe shall be entitled to (i) collect all monthly Greenlite Service Fees, including all fees for cashless services provided by Cantaloupe, (ii) collect all processing fees calculated in accordance with Exhibit A attached hereto, and (iii) any other amounts due and payable to Cantaloupe pursuant to any agreement between Customer and Cantaloupe, directly from the amounts received from Processor and prior to remitting the balance of such amounts to Customer. This right to retain payment from funds received from Processor shall in no way limit or impair Cantaloupe’s right to collect any amounts due and payable to Cantaloupe directly from Customer.


The Customer acknowledges that it is in compliance with PCI-DSS 9.9 requirements and any other requirements that may apply to it. Compliance requirements include: protecting cashless card readers from tampering and substitution, maintaining an up-to-date list of cashless vending machines, periodically inspecting device surfaces to detect tampering, and appropriate training of your employees to detect tampering. Detailed requirements may be found at:
https://www.pcisecuritystandards.org. Furthermore, Customer agrees to provide rights to audit in order to determine compliance.


For purposes of this Authorization, the MoR Transition Date shall be the date 10 days’ after Cantaloupe provides written notice (including delivery of notice within the Greenlite platform) to Customer that Cantaloupe has elected, in its sole and absolute discretion, to assume the role of Merchant of Record with respect to Customer’s cashless transactions (the “Transition Notice”). Delivery of the Transition Notice shall constitute acknowledgement of assumption by Cantaloupe, as of the MoR Transition Date, of all responsibilities associated with acting as the Merchant of Record for Customer’s cashless transactions, including without limitation providing response to customer billing inquiries and handling potential chargebacks. Cantaloupe shall have the right to charge Customer for reimbursement of all chargebacks and related fees paid by Cantaloupe for the account of Customer, and Customer hereby authorizes Cantaloupe to withhold any such amounts due to Cantaloupe from payments received from Processor without the requirement of further authorization.


Customer further agrees that at any time after the MoR Transition Date, Cantaloupe may elect to terminate its role as Merchant of Record for Customer transactions by providing at least 30 days’ prior written notice of such election.

Use your mouse or finger to draw your signature above
Date*

EXHIBIT A


  1. Processing fees shall be calculated at 5.95%. 
  2. If the semi-annual Card Associations Interchange or Processor fees increase, upon delivery of 30-day notice to Customer, Cantaloupe may increase rates to pass through such rate increase to Customer.

7. Greenlite Service Subscription Agreement

By signing this Subscription Agreement, you are agreeing to pay for the Software Services, Hardware, and Professional Services identified below and agree to be bound by the terms and conditions of the Master Service Agreement (MSA) and Cantaloupe One Terms & Conditions located at https://www.cantaloupe.com/legal/.The MSA and Cantaloupe One Terms & Conditions are incorporated herein and made a part of this Subscription Agreement by this reference.


This Agreement is effective as of the last signature date below ("Effective Date"). In the event of a conflict among terms, the order of priority shall be first, this Subscription Agreement, next the MSA, and lastly a detailed Sales Quote.

Service Plans (Choose 1 plan ONLY)*
NOTE**: Data plan provides access to sophisticated reports on the sales and machine behavior to enhance revenue generation and improve the health of your business
Engage Device Surcharge*
If you are ordering Greenlite kits to install in your *existing* vending machines, mark this box and a Greenlite representative will contact you to verify machine compatibility and to enter your Greenlite Kit order :*
Is this an upgrade from your legacy seed device (Orange box) or a brand new order?*
Activation Plan*

BILLING COMMENCEMENT DATE: Monthly Greenlite Service Fees will commence the earlier of (A) the first day a Greenlite Equipment Kit Device reports to Cantaloupe's servers, or (b) 90 days from date of shipment.


CONTRACT TERM COMMITMENT (Per Equipment Device): 36 months from Billing Commencement Date -- this means that Customer is assuming a non-cancellable obligation to subscribe and pay monthly fees for a period of 36 months from the Billing Commencement Date with respect to each Greenlite Equipment Kit Device installed. Thereafter, the service term period shall continue from month-to-month.


EARLY TERMINATION FEE: After 90 days, from date of Greenlite Equipment Kit shipment, a fee in the amount of $199 per Greenlite Equipment Kit will be assessed for each Greenlite Equipment Kit Device that is terminated by Customer prior to completion of the Contract Term Commitment.


RETURN OF GREENLITE EQUIPMENT UPON TERMINATION: At the end of the rental term you must return the equipment in good working order within thirty (30) days. Otherwise you will be charged $300 for each device that is not returned within thirty (30) days or in good working order upon its' return. This fee is in addition to any double billing of seed and eport or engage devices, and an Early Termination Fees which may be applicable. For more information contact Vendnet Technical Services at +1-515-271-8404. Please have the Greenlite Equipment Kit Device serial number available for the call to Vendnet Technical Services.


CUSTOMER'S SIGNATURE BELOW ACKNOWLEDGES THAT CUSTOMER HAS READ AND UNDERSTANDS EACH OF THE PROVISIONS OF THIS SUBSCRIPTION AGREEMENT MSA AND AGREES TO BE BOUND BY EACH OF THEM.


CUSTOMER ACKNOWLEDGES THAT THIS SUBSCRIPTION AND THE MSA CREATE PAYMENT OBLIGATIONS THAT MAY EXTEND BEYOND THE PERIOD OF USE OF GREENLITE BY CANTALOUPE'S PRODUCTS AND SERVICES AND CUSTOMER AGREES TO MAKE ANY SUCH PAYMENTS IN ACCORDANCE WITH THE TERMS OF THE MSA.

Use your mouse or finger to draw your signature above
Name*
Date*

8. W-9 Form Upload

Please follow this link to fill out, save, and upload your W-9 Form below... IRS W-9 Form


**What is a W-9 form for? All customers must fill out Form W-9, so as to notify the IRS of the amount paid out to you for tax validation purposes. The Form W-9 is used in a wide range of payment situations and is an essential contract in many Vending Services agreements.**


TAX ID NUMBER (Social Security Number or Employer ID) IS REQUIRED. Please ensure SSN or EID number is Entered and Saved.

Upload Your W-9 Form Here*
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***NOTE: W-9 IS REQUIRED BY LAW. THEREFORE, IF YOU DO NOT UPLOAD A COMPLETED W-9 HERE, YOUR ORDER WILL NOT BE PROCESSED. W-9 MUST BE SIGNED AND DATED OR IT WILL NOT BE ACCEPTED. NO EXCEPTIONS. THANK YOU.***

WELCOME TO GREENLITE!

Questions? Contact Greenlite at 515-271-5450


Once your application is submitted it may take 7-10 business days to process after all information is received.

Attach additional files here (Optional)...
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