Merchants

Submit to SBC Set as Pre-App

Merchant ID*

Legal Name*

DBA Name*

Processor

Agent*

Split*

Is Override*

Password*

Status*

Product Type

Received Date*

Approved Date

Activation Date

Closed Date

Address

Address 2

City

ZIP

Country

State

Contact

Email(comma separated)

Phone

Phone 2

Cell

Fax

URL

DBA Same as Legal Address

Address

City

ZIP

Country

State

Mailing Address Same as DBA

Address

City

ZIP

Country

State

File here *	Download	Notes *	Status	Date	Action
		Application
		DL too large to upload
		Var
		Voided check

Type*

Deployment Date*

EPI/TPN

Status*

Model*

Purchase T.*

Returned Date

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Type*

Deployment Date*

EPI/TPN

Status*

Model*

Purchase T.*

Returned Date

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Bank 1 Information

Bank Name

Account Name

Rounting Number

Account Number

Billing Type

Gross Settlement

Net Settlement

Bank 2 Information

Bank Name

Account Name

Rounting Number

Account Number

Overrides who receive partial commission on all of ADAM PARRIE Accounts

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

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

Merchant *

Month *

Year *

Merchant CMS

EIN/Federal Tax ID Type

MCC Code

EIN/Federal Tax ID #

State incorporated in

Business Start Date

Type of Legal Entity

Business Type

Sub Business Type

Types of Goods Sold

Primary Transaction Type

Card Swiped

%

Card Keyed In

%

Card Present

%

Card Not Present

%

Internet

%

Moto

%

B2B

%

B2C

%

Estimated Annual Sales Visa/MC/Discover/ AMEX Sales

Estimated Monthly Visa/MC/Discover/ AMEX Sales

Average Ticket

High Ticket

Persoanl Guarantor

Telephone Order

%

Discount Method

Refund Policy

30 Days

60 Days

Other

None

Print Refund Policy On Footer
(If Yes Input Message In Notes)

Yes

No

Location Type

Notes

Date

Reminder Date & Time

Employee

Notes

Sr. No.	Date	Reminder Date	Employee	Note	Documents	Created by	Updated at	Updated by	Action
1	Feb 18 2025 04:45 PM		Charlotte Groff	Adam called about a $22 fee that was debited from his account on January 6th. Called SBC to see what the fee was for and $15.00 of it was for a Retrieval request for a Discover customer for $811.88 taken on July 2nd. The response deadline date for the Retrieval Request was Jan 30th. SBC could not say if Discover would go ahead and push it to a Chargeback or not, but that Discover had 45 days beyond the Jan 30th deadline to do so. Adam knows he owes the customer the money and is willing to pay him, but didn't want to send him a check if he was going to get the Chargeback. I called Adam and suggested that he contact the cardholder and get written correspondence going to see if the customer will stop the chargeback process so that Adam can write him a check. Adam said that he'll wait until the 45 days is up and see if the chargeback has come through or not before writing him a check. He will call back about mid-march to check on the status of it becoming a chargeback. ALSO, part of the $22 fee debited was an automatic fee for PCI Non Compliance ($6.00) that was added to the retrieval fee. I submitted a request to have the $6.00 refunded to his account since he had been cancelled since October 2024.	-	Charlotte Groff	Feb 18 2025 06:51 PM		Update Delete
2	Oct 10 2024 01:58 PM		Charlotte Groff	Merchant signed cancellation request form and it was submitted to SBC and closed account on 10/7/24. Terminal is VX520 and is not needed back due to EOL.	-	Charlotte Groff	Oct 10 2024 02:01 PM		Update Delete
3	Aug 01 2023 12:00 AM			User: Charlotte Goff -> Notes: TT- Adam - He was inquiring about a debit to his account of $53.31. Researched his monthly statement and it was his monthly fees $119.55 minus his daily fees $66.24. The monthly fees also included the 2 debit network annual fees of $16 each.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
4	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Adam, walked him through a manual sale	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
5	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Adam, walked him through a manual sale	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
6	Aug 01 2023 12:00 AM			User: Pennye McAnulty -> Notes: Adam called about fees for the month. Went over them with him.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
7	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Adam changed auto settle time to 6:00 pm.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
8	Aug 01 2023 12:00 AM			User: Pennye McAnulty -> Notes: TT called about rates being charged went over them with him.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
9	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Adam changed auto settle time to 6:00 pm.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
10	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: Programmed VX520 SN 262-793-655 for dial. He will send other VX520 back to us.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
11	Aug 01 2023 12:00 AM		Morgan Withee	User: Morgan Withee -> Notes: Converted to Secure BanCard	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
12	Aug 01 2023 12:00 AM		Morgan Withee	User: Morgan Withee -> Notes: Old Concord Merchant Number: 02667540001	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
13	Aug 01 2023 12:00 AM			User: Kay Arpin -> Notes: 10-25-2018 outbound call for conversion, no answer	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
14	Aug 01 2023 12:00 AM			User: Christina Sullins -> Notes: tt Adam about swapping processors and he will get with Northern Leasing to see what it would cost to cancel and let us know.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
15	Aug 01 2023 12:00 AM			User: Christina Sullins -> Notes: tt Adam, he had $301.70 taken from his account on 03/24/17. it was a chargeback.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
16	Aug 01 2023 12:00 AM			User: Christina Sullins -> Notes: Adam called asking what is his Voice rate, 3.24%	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
17	Aug 01 2023 12:00 AM			User: Linda Billings from - Notes: Adam called to ck debit from acct for $94.95, not our fees, was from merchant service, probably final bill from previous processor.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
18	Aug 01 2023 12:00 AM			User: Linda Billings from - Notes: Adam called and does not want to go to Gross Monthly as previously thought, likes daily now that he's use to it.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
19	Aug 01 2023 12:00 AM			User: Linda Billings from - Notes: Adam recv'd terminal, called to initialize, not downloaded, teleconf in & no profile built. Got profile built & download problem. Will get a call in 15 to 20 minutes for download.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete

Application Type

Discount

Business Type

MCC Code

Visa/MC/Discover Rate Category

Base/Qualified (%)

Mid Qualified (%)

Non Qualified (%)

Base Debit- Non Pin Debit(Sig Debit Rate) (%)

Rewards Discount (%)

Statement Fee

Card On File Fee

PCI Fee

Non PCI Compliance

Authorization Fee

Per Item Fee

EBT Fee

FNS/EBT Number

Pin Debit Item Fee

Pin Debit Discount

Amex Opt Blue Rate

Base/Qualified Rate (%)

Mid Qualified Rate (%)

Non Qualified Rate (%)

Program Cost Opt Blue (%)

Authorization Fee

Per Item Fee

Other Monthly Fee

Ancillary Fees

Batch Fee

Retrievel Fee

Chargeback Fee

ACH Change Fee

Voice Auth Fee

Gateway Monthly Fee

Setup Fee

Owner 1 Information

Officer/Owners Name

Title

Social Security

Form of ID

ID #

Issue Date

Expiration Date

State

DOB

Home Phone Number

% of Business Owned

Length of Ownership

Home Address

Home city

Home state

Home country

Home zip

Owner 1 Information

Officer/Owners Name *

Title

Social Security

Form of ID *

ID # *

Issue Date *

Expiration Date *

State *

DOB *

Home Phone Number

% of Business Owned

Length of Ownership

Home Address *

Home city *

Home state *

Home country

Home zip *

Software Or POS Integration Questions Only

POS Software Integration

Yes

No

Software Name & Version:

Pricing Provided

Statement Analysis

Quote

POS Software Publisher

Seasonal Flag

Seasonal Months

Deposit Time Frame

Deposit Type

Network ID

MP/AP Name

RP Name

Receipt Header Message

Receipt Footer Message

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