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: 118220725577 Returned

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 Advanced Dermatology Skin 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	Feb 18 2025			Returned VL100
2	Aug 30 2024		Mike Thomas	Sent Kristi return label for Valor terminal
3	Aug 28 2024		Mike Thomas	TT Tabitha about updating to WP and she said they weren't using our terminals now, she said she would have Kristi call our office.
4	Jan 08 2024		Mike Thomas	TT Tabitha, she says she ran a refund for $75 which I can see and TSYS says was approved by the issuing bank. The customer says that card was cancelled. TSYS says the customer should call the issuing bank for clarification. i advised Tabitha.
5	Jan 05 2024		Charlotte Groff	Jennifer called about a couple of transactions that were processed on the Valor yesterday. A lady tried to pay with her HSA card 3234 for $60.00 but it was declined for insufficient funds. So she paid with a different card 5180. Then they refunded the card 5180. It does look like the HSA card was approved for a partial amount of 10.58 (according to IQ Auth Log) but did not settle because Valor reversed the transaction since it was not a full amount.
6	Jan 03 2024		Charlotte Groff	Added Shelly Schefke as a contact person and changed Valor Batch reports to be emailed to [email protected]
7	Aug 01 2023			Valor Login for Admin: Username: clockAD , Password: Poplarpike7
8	Aug 01 2023			TT Dana, Tabitha, and Rebecca walked them through set up on VL100 and VT, also added Rebecca as user
9	Aug 01 2023			Charlotte and I downloaded a VL 100 terminal and VL 300 pin pad along with the VT. Mike will get this couriered out via express courier
10	Aug 01 2023			Entered in rate reduction with tonya to go active 3/1/23. attached rate reduction form in documents and merchant file
11	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT DeeDee walked her through adding a user and doing reports by user
12	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Changed open credit policy to no refunds per Emily K.
13	Aug 01 2023			User: Pennye McAnulty -> Notes: Sent paperwork for American Express. Melissa stated the card readers are not taking Mastercard.
14	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Ordered 2 MP200 card readers shipping ground to merchant. (ordered 1/30/18)
15	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Set up USA ePay

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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