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
		voided check
		signed app
		var
		pre app
		DL

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

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 Drs Smith & Tutor 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 21 2025			Received letter to cancel both Drs Smith and Tutor locations. Submitted to WorldPay support email address.
2	Jan 21 2025			Stacey called and said she had talked with Alex regarding the cancellation of this account. They closed this account due to partners changing. They have a Pax S80 terminal so I told them there was no need to send the terminal back since it's end of life. I did tell her that we do have to have an email from Dr. Smith stating name of his business, MID, business address and Tax ID and the fact that they've closed their business.
3	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Cat updated terminal to accept tap transactions
4	Aug 01 2023			User: Charlotte Goff -> Notes: Jeanie called in and said that her co-workers couldn't remember if they batched out for the 9th - 11th while she was out on vacation. I checked in IQ and there were no settlement record but confirmed that the authorization amounts we showed for each day matched her totals that she has. She will run the batch tonight to close out all the days
5	Aug 01 2023			User: Charlotte Goff -> Notes: Jeanie called in saying she received an email about becoming PCI compliant and wanted to know if it was from her old processor or the new one. I asked her for the MID on the email and she gave me last 4 digits of 3089. I informed her that the email is from the new processor and that she will need to become compliant for both of their locations or she will start receiving a high monthly fee for non-compliance. Told her how to get started and she said she'd take care of it.
6	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Jenni called in she ran a test transaction and it was asking her questions. I let her know that happens sometimes with corporate cards just enter through and it should process normally
7	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Jenni advised her that the password for a VOID is the current date.She is now using the PAX S80
8	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Downloaded PAX S80
9	Aug 01 2023			User: Charlotte Goff -> Notes: Vantiv; Traditional; Conversion from Elavon + name change;
10	Aug 01 2023			User: Charlotte Goff -> Changed : TO Percent FROM 0 TO 1
11	Aug 01 2023			User: Charlotte Goff -> Changed : Swipe Percent FROM 0 TO 99
12	Aug 01 2023			User: Charlotte Goff -> Changed : MonthlyVolume FROM 0.00 TO 15000
13	Aug 01 2023			User: Charlotte Goff -> Changed : AnnualVolume FROM 0 TO 280000
14	Aug 01 2023			User: Charlotte Goff -> Changed : AverageTicket FROM 0.00 TO 600

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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