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

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

Send Email to Merchant Send Email to Sales rep Send Email to Employee Delete

Type*

Deployment Date

EPI/TPN

Status*

Model*

Purchase T.*

Returned Date

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Send Email to Merchant Send Email to Sales rep Send Email to Employee Delete

Type*

Deployment Date

EPI/TPN

Status*

Model*

Purchase T.*

Returned Date

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Send Email to Merchant Send Email to Sales rep Send Email to Employee Delete

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 Forklifts ETC 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	Dec 20 2023 12:00 AM		Charlotte Groff	Closed account. Not using IBUXX account anymore. Will use traditional account. Closed on SBC 12/20/23	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
2	Dec 20 2023 12:00 AM	Dec 20 2023	Mike Thomas	Tricia returned 3 VL100 12/20/23 SN: 118221707365, 118213111803, and 1182217017372	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
3	Dec 19 2023 12:00 AM		Morgan Withee	I think we need to close out this account. I will get with Tricia on this!	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
4	Dec 19 2023 12:00 AM		Morgan Withee	TT Tricia - She let me know that the merchant no longer wants to do ibuxx. At this time we also realized that they never got their ecommerce site connected to their auth.net account with SBC. Previously they had an auth.net account on their ibuxx account. I had conrad switch over the mid in the back ground so that it would now be associated with their traditional mid. This way the merchant did not have to pay for a new auth.net account. Tricia gave us a contact for their virtuemart shopping cart- [email protected]. Sent the following email to merchant and contact with the auth.net information Good Afternoon, My name is Morgan Withee, and I am working with Forklifts ETC on their new merchant account. We have them boarded on Tsys with an authorize.net var sheet. Lance gave our office this email address to assist you with getting their shopping cart set up on authorize.net. To my understanding, their website will not be passing a fee along to their customers like we originally planned. Authorize.net Credentials: username: forkliftsetc2023password: Forklifts2023! They do have 2-factor authentication turned on though so once you login it will send a pin to Lance's email. The pin is only good for 10 min so you may want to have the merchant on the phone while you are trying to login. I tried to disable this but auth.net says this is a new requirement and we can not disable this. I have attached their var sheet just in case you may need it but it's all set up in authorize.net so there should be nothing needed on that end. Please let us know if there is anything we can do to assist you from our end.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
5	Aug 01 2023 12:00 AM			Called Karri per text from Tricia. She was needing Virtual Terminal access. Requested the vars and set up VT for her. She was able to see it after she logged out and back in.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
6	Aug 01 2023 12:00 AM			TT Tricia wanted survey removed from Valor.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
7	Aug 01 2023 12:00 AM			Correction: SBC- IBUXX- 3.5%- Swipe Simple- IP- NDF	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
8	Aug 01 2023 12:00 AM			Was set up for 3.95% but should have been 3.5% so I have updated this in pioneer.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
9	Aug 01 2023 12:00 AM			I have gotten this taken care of they will have 1 valor terminal with both a traditional mid and an ibuxx mid. Then we are doing their website on ibuxx with authorize.net. I am working with the developer on this now	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
10	Aug 01 2023 12:00 AM			SBC- Ibuxx- 3.95%- Valor- IP- NDF - terminal will have dual mids one traditional and one ibuxx. Merchant will select cancel to remove fee and that will run on the traditional mid.	-	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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