Merchants

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Merchant ID

Legal Name

DBA Name

Processor

Agent

Split

Is Override

Password

Received Date

Approved Date

Activation Date

Closed Date

Product Type

Status

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

Type

Install Date

Equipment ID

Status

Model

Purchase T.

PD Telephone

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Type

Install Date

Equipment ID

Status

Model

Purchase T.

PD Telephone

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

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

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 Centerville Wine and Spirits Inc 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 #

Type of Legal Entity

State incorporated in

Types of Goods Sold

Primary Transaction Type

Internet

%

Swipe

%

Keyed

%

Average Ticket

Telephone Order

%

Annual Volume

Business Start Date

High Ticket

Persoanl Guarantor

Monthly Volume

Discount Method

Refund Policy

30 Days

60 Days

Other

None

Date

Reminder Date & Time

Employee

Notes

Sr. No.	Date	Reminder Date	Employee	Note	Action
1	Aug 01 2023			Received notification from PCS that they have cancelled this account in their system.
2	Aug 01 2023			Cancelled account. Sent signed Cancel Request to PCS on 3/23/23 ticket ID 4400729
3	Aug 01 2023			Called Alan and told him that we've been trying to send him the Cancellation form that he needs to sign to get his account closed. Resent the docusign again and also emailed him the phone number for Clover since he has never used his clover dashboard to cancel his clover
4	Aug 01 2023			Sent Alan Docusign for PCS Cancellation form after he sent Morgan an email stating he wanted to cancel
5	Aug 01 2023			PCS transferred Alan to us and he wants to cancel his account. I did tell him that we require the PCS form to be filled out and returned to us and he also wanted to know about getting his Clover cancelled so that the $51.53 doesn't come from his account anymore. Sent email to Alan on 3/17 letting him know how he can cancel his Clover and sent the PCS form for his signature
6	Aug 01 2023			User: Emily Karawadra -> Notes: Walked merchant through his statement. He feels his effective rate should be lower. He is going to see november statement . We will adjust rate if need be.
7	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Walked Alan through his invoice explained what he was paying for then showed him how to pay it. Told him his clover should be there in a few days.
8	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : BankName FROM First TO First Farmers
9	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : AverageTicket FROM 0.00 TO 20
10	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : AnnualVolume FROM 0 TO 1380000
11	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : Swipe Percent FROM 0 TO 95
12	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : TO Percent FROM 0 TO 5

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

Y N

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

Y N

Home Address *

Home city *

Home state *

Home country

Home zip *

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