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

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 Jamie Hendrix 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		Morgan Withee	User: Morgan Withee -> Notes: updated monthly fee from $29.95 to $19.95
2	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Terminal not processing...he checked phone line and got no dial tone...plugged in different line and it works. He may now consider using ethernet
3	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Got the signed form and better image of the voided check. I have submitted it to linda for updating
4	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Molli emailed me she wants to get this DDA changed for merchant. She sent over a copy of the voided check but it was not very clear. I sent her over the ACH change form for his signature and requested a new copy of voided check. Once I get that back I can submit for change. I saved the unsigned copy of the form in the merchant file.
5	Aug 01 2023			User: Charlotte Goff -> Notes: TT - Jamie Hendrix and he ran a transaction on an Amex card on July 19th for $379.42 but as the terminal was about to dail out he received a fax which interrupted his terminal. The terminal received and error on it. He entered his transaction again for the 379.42 and received an approval and it was settled and paid to him. Cardholder called Jamie and said that he was showing a $1418.92 pending transaction on his Amex statement in addition to the $379.42. I could see the authorization in Pioneer for both of the transactions but only the 379 was settled. Called Linda at SBC and she checked in TSYS and said that the 1418.92 had been immediately voided and cardholder should not be charged. Told Jaime that cardholder should see that pending amount fall off his statement within the next few days.
6	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: NX 1200 Terminal 0002 TID:76652731 S/N: 3318X16355
7	Aug 01 2023			User: Emily Karawadra -> Notes: Making change to put on dial Morgan will call back at 1pm to make switch as they are going to lunch
8	Aug 01 2023			User: Emily Karawadra -> Notes: Molly notified office that terminal is down tried to make contact this am. left voicemail. Sound like ethernet conncection issue
9	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : TO Percent FROM 0 TO 2
10	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : Swipe Percent FROM 0 TO 98
11	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : MonthlyVolume FROM 0.00 TO 12000
12	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : AnnualVolume FROM 0 TO 350000
13	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Changed : AverageTicket FROM 0.00 TO 1000

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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