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
		DL
		Business License
		Bank Info
		Bank Letter
		Signed App
		Secure Bancard TSYS VAR Sheet

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

Bluetooth Dongle - Batch time 7:00pm Central;  Receipt Header and Receipt Footer (see pre app)

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 Kimberly Johnson 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	Jan 30 2025		Charlotte Groff	January fees were returned due to Account Frozen. Tried to call the merchant to see if we can do a bank account change and the phone on file has been disconnected. I called Anna Kate - the MP - and left a voicemail for her letting her know we need her to try to contact the merchant for us and let us know what's going on. Merchant currently owes $29.95 plus a $25 fee for the returned ACH.
2	Jan 10 2025		Charlotte Groff	Received message from Conrad about returned ACH for January billing of $29.95. Called merchant and left a voice mail for her to call the office. We need to know when she will have the funds in the account so that they can send the debit for the fees back out
3	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Anna after hours and gave info
4	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Anna tried to schedule a time to call merchant to do card reader set up. She has to do it after hours so I went through the contents of the box and gave her some details about setting it up. I also sent her my cell number.
5	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Updated firmware and shipped FedEx
6	Aug 01 2023			User: Charlotte Goff -> Notes: Changed status to Approved; uploaded Var; added MID and approval date
7	Aug 01 2023			User: Charlotte Goff -> Notes: SBC - IBUXX - 3.95%; Swipe Simple Mobile app with Bluetooth dongle; Batch time 7:00pm; Receipt Header and Footers listed on Pre-App
8	Aug 01 2023			User: Charlotte Goff -> Changed : TO Percent FROM 0 TO 50
9	Aug 01 2023			User: Charlotte Goff -> Changed : Swipe Percent FROM 0 TO 50
10	Aug 01 2023			User: Charlotte Goff -> Changed : MonthlyVolume FROM 0.00 TO 500
11	Aug 01 2023			User: Charlotte Goff -> Changed : AnnualVolume FROM 0 TO 5000
12	Aug 01 2023			User: Charlotte Goff -> Changed : AverageTicket FROM 0.00 TO 20.00
13	Oct 06 2022	Oct 06 2022		TT Anna after hours and gave info
14	Oct 06 2022	Oct 06 2022		TT Anna tried to schedule a time to call merchant to do card reader set up. She has to do it after hours so I went through the contents of the box and gave her some details about setting it up. I also sent her my cell number.
15	Oct 06 2022	Oct 06 2022		Changed status to Approved; uploaded Var; added MID and approval date
16	Oct 06 2022	Oct 06 2022		Updated firmware and shipped FedEx
17	Oct 06 2022	Oct 06 2022		SBC - IBUXX - 3.95%; Swipe Simple Mobile app with Bluetooth dongle; Batch time 7:00pm; Receipt Header and Footers listed on Pre-App
18	Oct 06 2022	Oct 06 2022		AnnualVolume FROM 0 TO 5000
19	Oct 06 2022	Oct 06 2022		MonthlyVolume FROM 0.00 TO 500
20	Oct 06 2022	Oct 06 2022		Swipe Percent FROM 0 TO 50
21	Oct 10 2022	Oct 10 2022		TO Percent FROM 0 TO 50

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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