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
		pre app
		Signed Cancellation Request

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

Uses ECRS software - Data Cap gateway through bypass

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 Natural Food Store 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	Oct 15 2024		Charlotte Groff	Received signed cancellation form from merchant. Submitted it to PCS - case number 04012749
2	Oct 09 2024		Charlotte Groff	Cancelled merchant account per email received from Krystal Quattlebaum on 10/8/24. Sent email to PCS to cancel the account in their system. A support case with number 03993957. Received email back from PCS to have merchant sign the required Cancellation Request form. Sent the form to the merchant for her signature.
3	Oct 08 2024		Mike Thomas	TT merchant , wants to cancel...gave them the support email and advised Lisa
4	Aug 08 2024		Charlotte Groff	Eric called and needed to know what his Gift Card Entitlement number was. I called PCS Tech Support Dept and they gave me the entitlement number 56903360002
5	Aug 01 2023			TT Krystal she says 2 transactions that said declined but the customer see's both on online banking. Called Rise and she says there is a network outage that they are aware of but no time frame for the fix. They both were declined. they should drop off customers account.
6	Aug 01 2023			User: Charlotte Goff -> Notes: TT- Krystal - she's having issues with her shopping cart communicating with the software. Referred her back to her software company.
7	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Krystal called in She said a customer came in on 8/10 to make a purchase of $60.35 in card ending in 5259. The customer came in today and said they see the transaction on their bank account twice. I only see 1 transaction in client line. I told her that the other one should fall off. If it does not please call back and I can dig deeper. But from my end I only see they were billed once.
8	Aug 01 2023			User: Aimee Jones -> Notes: Called with PCI questions. They are good and compliant.
9	Aug 01 2023			User: Emily Karawadra -> Notes: called mercury for giftcard info their userid to portal.mercurypay.com is Krustal_Quattlebaum
10	Aug 01 2023			User: Kay Arpin -> Changed : TO Percent FROM 0 TO 15
11	Aug 01 2023			User: Kay Arpin -> Changed : Swipe Percent FROM 0 TO 75
12	Aug 01 2023			User: Kay Arpin -> Changed : MonthlyVolume FROM 0.00 TO 70000
13	Aug 01 2023			User: Kay Arpin -> Changed : AnnualVolume FROM 0 TO 850000
14	Aug 01 2023			User: Kay Arpin -> Changed : AverageTicket FROM 0.00 TO 85

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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