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
		signed app
		voided check
		pre app

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

Send Email to Merchant Send Email to Sales rep Send Email to Employee

Type

Install Date

Equipment ID

Status

Model

Purchase T.

PD Telephone

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

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 Mark T Hanstein DDS 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			CANCELLED - CONVERTED TO SBC
2	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Comms errors advised to reset router try new cable. She will call internet provider if all else fails
3	Aug 01 2023			User: Charlotte Goff -> Notes: TT - Melanie - she needed to know how to run a refund on her terminal. Also needed help with a couple of chargebacks ($100 & $134) she received where she had already processed a refund for $234 on July 6th. Conferenced her in with Eleavon Disputes Dept and they told her to respond to both CBs and send a copy of the refund receipt.
4	Aug 01 2023			User: Charlotte Goff -> Notes: Called to get help with running a refund. Walked her through the process and receipt was printed with the refund amount and approval
5	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Called to get help voiding a transaction. I walked her through it. It printed the receipt and I told her that the patient may see it under the pending transactions on her bank account however it will fall off since we voided it.
6	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Melanie called in stating her terminal said Elavon must Settle conferenced in Elavon. Merchant just needed to settle out terminal
7	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: shipped VX820 pin pad
8	Aug 01 2023			User: Emily Karawadra -> Notes: spoke to Melanie about her statement. She wants to add pin debit. Sent email of quote to add.
9	Aug 01 2023			User: Emily Karawadra -> Notes: lm for Melanie to go over statement.
10	Aug 01 2023			User: Aimee Jones -> Notes: Melanie called with questions bout he statement.
11	Aug 01 2023			User: Pennye McAnulty -> Notes: Needs to go over rates. Will call back to go over rates. Also needs to be set up with PCI. I created the merchant a login Markhanstein.
12	Aug 01 2023			User: Pennye McAnulty -> Notes: The terminal continues to dial through the phone line. The phone line was plugged in. We unplugged the phone line from the terminal. We then reset the modem. Ran a test transaction and it worked fine.
13	Aug 01 2023			User: Pennye McAnulty -> Notes: Called to set up VX520. I walked them through plugging the terminal in and running a cc transaction. It was successful.
14	Aug 01 2023			User: Kay Arpin -> Changed : TO Percent FROM 0 TO 5
15	Aug 01 2023			User: Kay Arpin -> Changed : Swipe Percent FROM 0 TO 95
16	Aug 01 2023			User: Kay Arpin -> Changed : MonthlyVolume FROM 0.00 TO 17000
17	Aug 01 2023			User: Kay Arpin -> Changed : AnnualVolume FROM 0 TO 197000.
18	Aug 01 2023			User: Kay Arpin -> Changed : AverageTicket FROM 0.00 TO 380

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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