Name

Telephone

Company

Accepting

Currency

Kiosk

Wall Mounted

Floor Standing

On-Line Order Form - Select requirements and click Submit button

Cabinet Type required

Accept Notes & Coins

Accept Notes Only

Accept Coins Only

Cabinet Colour

YELL OW

RED

BLUE

WHI TE

BLA CK

Sterling [ £ ]

Euro

Dollar

Other Currency

Weatherproof

Pay out required [ Shown in Pence / Cents] [ Coin 1 - Coin 2 ]

2

5

10

2

20

25

50

100

Other add

To Notes

Quantity

required

Notes

Slim Wall

Add

<=To

Notes

2

5

10

2

20

25

50

100