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
		Pre Application
		Cancel Letter

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

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 Crescent Mountain, LLC 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 09 2024 11:22 AM		Charlotte Groff	submitted request to SBC to have refund issued (per Emily) for January and February billing. Requested $99.80 to be refunded. Responded to the merchant's inquiry.	-	Charlotte Groff	Feb 09 2024 05:23 PM		Update Delete
2	Feb 06 2024 10:31 AM		Charlotte Groff	Submitted cancellation request to SBC today.	-	Dee Karawadra	Feb 06 2024 04:32 PM		Update Delete
3	Jan 03 2024 12:00 AM		Mike Thomas	Returned VL 500 SN: 141221904546	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
4	Dec 06 2023 12:00 AM		Morgan Withee	Allison decided valor would not work for her needs. Mike sent her a cancel letter and return label. I got the cancel letter back today. I saved this in their google folder as well as documents here. Once we get the equipment back we can go ahead and submit for the cancel.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
5	Dec 05 2023 12:00 AM	Dec 05 2023	Mike Thomas	Emailed return label for Valor VL 500	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
6	Nov 29 2023 12:00 AM			TT Allison along with Jonathon from Valor to answer concerns and also to make make change on terminal to fit her needs	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
7	Nov 28 2023 12:00 AM	Nov 28 2023	Mike Thomas	TT Allison and answered questions concerning Valor. Also changed the batch time to 11:00 pm and updated user name to correct spelling. I am calling her back at 10:00 am tomorrow morning to go over some other questions she may have as she has appointments this morning.	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
8	Nov 21 2023 12:00 AM	Nov 21 2023	Mike Thomas	Downloaded VL 500 and shipped 2 day delivery (should be there Friday)	-	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
9	Nov 21 2023 12:00 AM			SBC IBUXX Valor 500 - Cellular Batch - 7:00PM EST Tip Edit	-	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

Cancel