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

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 CC Reliable Business Services 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		Mike Thomas	User: Mike Thomas -> Notes: Unlocked keyboard (press 8 enter password and select no)
2	Aug 01 2023			User: Alex Gibson -> Notes: I spoke to Paul with PRM, and he is still waiting to here from Risk regarding the $2,852 return. He said he would contact Risk and get back to me on the status.
3	Aug 01 2023			User: Christina Sullins -> Notes: Refund fraud case # PC 02193230
4	Aug 01 2023			User: Christina Sullins -> Notes: Peggy notified us by email that this account had 4 fraudulent refunds. WE contacted PRM and they are researching. All cards were swiped on terminal 1 and were refunds.
5	Aug 01 2023			User: Christina Sullins -> Notes: Between TT Robin and Peggy, we figured out that the terminals were not on dedicated lines. Peggy will call Robin and explain what needs to happen to avoid the batch failure issue.
6	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Shipped VX520 next day
7	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: VX520 s/n 288-652-756
8	Aug 01 2023			User: Christina Sullins -> Notes: OSM# 2525122 for New Schedule A changes for 10/01/15
9	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Request ID: 857485 to add 2 VX520DC
10	Aug 01 2023			User: Christina Sullins -> Notes: Sent Peggy August statment
11	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Robin, needed to know how to get to idle screen after she recycled the power. (select Softpay) She also need to know which key is the alpha key. (alpha key)
12	Aug 01 2023			User: Christina Sullins -> Notes: The terminal line is shared by the fax.
13	Aug 01 2023			User: Christina Sullins -> Notes: Robin is getting Re try again, CE. The terminal is on Ethernet. We tried resetting the terminal and now it won't say sale on the screen. (unplugged power and replugged) Left note for Mike to call them back.

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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