Agents

ID

Legal Name*

Agent Code*

Category*

Active

Password*

Adjust Negative Payout*

Negative Payout Percentage

Info
Company Info

First Name*

Last Name*

Address

City

ZIP

State

Country

Contact

Email(comma separated)

Work Phone

Extension

Home Phone

Cell

Flex

URL

Company Name

Address

City

ZIP

State

Country

Email

phone

File here *	Description *	Action

Date

Employee

Notes

Default Split Value %

Processor Wise Split %

Processor	Split	Remove
		Delete

Pay To (Legal)

Social Security Num.

Tax ID

Telemarketer

Default T. Commission

Bank Name

Bank Phone

Rounting Number

Account Number

Transaction Program

See Residual Detail

Agents who receive partial commission on all of OAKLAND PHYSICIANS Accounts (Overrides Default)

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Default Setup

Agent 1 Receives

%

on all Newly Inputted Accounts

Agent 2 Receives

%

on all Newly Inputted Accounts

Agent 3 Receives

%

on all Newly Inputted Accounts

Agent 4 Receives

%

on all Newly Inputted Accounts

Processor wise Setup (Overrides Default)

Select Processor *

Agent 1 Receives

%

on all Newly Inputted Accounts

Agent 2 Receives

%

on all Newly Inputted Accounts

Agent 3 Receives

%

on all Newly Inputted Accounts

Agent 4 Receives

%

on all Newly Inputted Accounts

Select Processor *

Agent 1 Receives

%

on all Newly Inputted Accounts

Agent 2 Receives

%

on all Newly Inputted Accounts

Agent 3 Receives

%

on all Newly Inputted Accounts

Agent 4 Receives

%

on all Newly Inputted Accounts

Agent *

Month *

Year *

Default Override

SBC

Sales Number

Sales Office

Owner Username

Vantiv

Sales Number

Sales Office

Owner Username

Rise CC

Sales Number

Sales Office

Owner Username

Rise PCS

Sales Number

Sales Office

Owner Username

Elavon

Sales Number

Sales Office

Owner Username

Tesla FD

Sales Number

Sales Office

Owner Username

FDR - Concord

Sales Number

Sales Office

Owner Username

Rev19 - AFS FD

Sales Number

Sales Office

Owner Username

PCS Direct

Sales Number

Sales Office

Owner Username

Clearent

Sales Number

Sales Office

Owner Username

Shift4

Sales Number

Sales Office

Owner Username

OLD RISE

Sales Number

Sales Office

Owner Username

Rev 19 - AFS TSYS

Sales Number

Sales Office

Owner Username

MAG

Sales Number

Sales Office

Owner Username

istream

Sales Number

Sales Office

Owner Username

Sr. No.	DBA Name	MID	Date Added	Status	Status Change	Processor	Approval	Split	Is Override / Is Merchant
1	BLOOMFIELD HEARING CENTER	434478159883	May 09 2023	CANC	Jun 10 2024	-	-	-	Merchant
	Address : -					Phone : 248-334-9490		Contact : Stacey Engel
2	MICHIGAN EAR NOSE AND THROAT	434478124887	May 09 2023	CANC	Jun 10 2024	-	-	-	Merchant
	Address : -					Phone : 248-334-9490		Contact : Stacey Engel
3	ALKAPA CHILD CARE PC	434477449889	May 09 2023	CANC	Jun 05 2024	-	-	-	Merchant
	Address : -					Phone : 248-674-0401		Contact : F.S. KAPADIA
4	Bloomfield Surgical Associates PC	434454950883	May 09 2023	CANC	Jun 05 2024	-	-	-	Merchant
	Address : -					Phone : 248-338-7171		Contact : Debra Rainney

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