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
		DL too large to upload
		ein
		pre app
		voided check

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

has label printer as well

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 Columbine Coffee House 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			User: Charlotte Goff -> Notes: Added Suite 24 to their address. AFS was getting mail returned. Called them and they updated their system.
2	Aug 01 2023			User: Charlotte Goff -> Notes: Called Curry to let her know that the refund of $147.90 has been ACH'd to her account and she should see the funds tomorrow. This refund was for the recalculation of fees for their PIN Debit transactions to credit card transactions. When I called it went straight to voicemail so I left her a detailed message explaining what it was for and how much. Told her to call with questions.
3	Aug 01 2023			User: Charlotte Goff -> Notes: TT Curry - she wanted to know why she was debited $461.43 for her processing fees for only 9 days of transactions. Emily did a deep dive and determined that most of her fee was coming from the PIN debit transactions that they have been taking. Told Curry that we need to have PIN debit deactivated in their Clover. Her daughter googled it and they removed the ability to process PIN debit in their machine on their own. She's upset at the amount of fees she's being charged and is strongly considering cancelling because she feels like she's been lied to. Called Tricia and filled her in. Tricia is calling Curry to discuss the situation with her.
4	Aug 01 2023			User: Charlotte Goff -> Notes: TT - Curry - she was having problems reconciling. She is only processing on weekends right now. When she ran her batch total for 17th & 18th the days were added together in the Clover batch report and she wasn't seeing that deposit amount in her account. She saw the deposit for 17th but was thinking that it was the deposit for last weekend (10th). Her deposit for the 10th transactions is being held by her bank for some reason. She isn't confused anymore and she understands that her days will be deposited separately. Also gave her pricing for new labels via email.
5	Aug 01 2023			User: Leah Faber -> Changed : AverageTicket FROM 0.00 TO 5.00
6	Aug 01 2023			User: Leah Faber -> Changed : Swipe Percent FROM 0 TO 90
7	Aug 01 2023			User: Leah Faber -> Changed : TO Percent FROM 0 TO 10

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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