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

SN: 118224735848

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 OB-GYN Centers of Memphis PLLC 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	Dec 30 2024		Charlotte Groff	Talked to Annie - she had a customer that paid $100.00 on card 3983 this morning on 12/30/24. His bank is showing 3 additional transactions pending for the same amount all done within minutes. I can only see one transaction in Valor and suggested that the cardholder call his bank and see if those transactions can be reversed.
2	Aug 29 2024		Mike Thomas	Updated terminal to WP
3	Dec 13 2023	Dec 13 2023	Mike Thomas	TT Annie, VX520 will not read chip cards will replace with used Valor 100. Will ship as Monday when Annie is back in the office.
4	Oct 27 2023		Morgan Withee	TT Merchant went over PCI and what they need to do to complete: Validation status and profile status. I gave her their MID and reset her password. I let her know if she has any trouble please call us back.
5	Aug 01 2023			User: Charlotte Goff -> Notes: TT - Annie - Her VX520 terminal was asking for a password. Gave her the 11739 and she was able to get it going again.
6	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Annie called in about her PCI. I directed her to the webpage and told her how to complete it. I told her to call the helpdesk but if they are not helpful then we will conference her on the phone with the helpdesk to ensure they help her.
7	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Annie and also emailed her all the info 11/24 concerning PC!
8	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT merchant and left a voicemail for Annie to call me concerning PCI
9	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Annie line busy reset terminal...not working...advised how to test phone line and advised to try new phone cord.
10	Aug 01 2023			User: Pennye McAnulty -> Notes: Needed batch report for 01-30-2018

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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