Created On Oct, 09 2024 21:13pm ID #7856

Pre-app Cover Details

Attached Required Document Checklist :
Voided check
Merchant (Business) DBA Name :
First National Bank of Eastern Arkansas - Forrest City
Business Legal Name :
First National Bank of Eastern Arkansas
Contact Name :
Mercedes Mitchell
Contact Phone Number :
870-633-2857
Physical Address :
123 North Izard Street, Forrest City, AR, USA
City :
Forrest City
State :
AR
Country :
USA
Zip :
72335
Phone Number :
Fax Number :
870-633-2383
Email Address :
mmitchell@fnbea
Website :

Billing Address

Address :
PO BOX 2019
City :
Forrest City
State :
AR
Country :
Zip :
72336

Business Type

State incorporated in :
Public
Type of Legal Entity :
Business Type :
Business Start Date :
-
EIN/Federal Tax ID Type :
Employer Identification Number
EIN/Federal Tax ID# :
*****8070
Types of Goods Sold :

Ownership Information

Owner 1

Officer/Owners Name:
Brice Fletcher
Title :
Chairman
Social Security:
Home Address:
City :
State:
Country:
Zip:
Drivers License:
Issue Date:
Jan, 01 1970
Expiration Date:
Jan, 01 1970
State:
DOB:
Jan, 01 1970
Home Phone Number:
% of Business Owned :
Length of Ownership :

Banking Information

Billing Type :
Name of Bank :
First National Bank of Eastern AR
ABA Routing :
084101417
Account :
*****1111

Estimated Sales Volume

Estimated Annual Sales Visa/MC/Discover/ AMEX Sales :
$
Estimated Monthly Visa/MC/Discover/ AMEX Sales :
$
Average Ticket :
$
High Ticket :
$

Business Profile

Card Swiped :
0%
Card Keyed In :
0% = 0%
Card Present :
0%
Card Not Present :
0% = 0%
Moto :
0%
Internet :
0%
-
Notes :

Terminal Answer

Batch Out Time :
11:00 AM
Terminal Type :
Communication Method :
IP-internet
Do You Dial 9 For Outside Line? :
Yes
Reprogram Terminal :
Yes
Equipment Purchase :
Yes
Equipment Rental Program :
Yes
Next Day Funding :
Yes
Tip Edit :
Yes
EBT :
Yes
FNS Number :
Tax Calculation :
Yes
If So Tax Rate :
Refund Policy :
30 Days
Print Refund Policy On Footer :
Yes

Software Or POS Integration Answer

POS Software Integration :
Software Name & Version :
MP/AP Name :
RP Name :
Pricing Provided :
Statement Analysis
Receipt Header Message :
Receipt Footer Message :

Front Drivers License

Back Drivers License

Video Check