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

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 and Cancer associates 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			Valor Login for Admin: Username: clockAD , Password: Poplarpike7
2	Aug 01 2023			Entered in rate reduction with tonya to go active 3/1/23. attached rate reduction form in documents and merchant file
3	Aug 01 2023			User: Pennye McAnulty -> Notes: Called Gem Team to get Auth.net credentials. Emailed credentials to John Gehrig: 2128905
4	Aug 01 2023			User: Pennye McAnulty -> Notes: The Auth.net TID is already being used on this account. I requested a new one for Visha.
5	Aug 01 2023			User: Pennye McAnulty -> Notes: They are on Auth.net using Shopify for the website and the USA Epay is for the mobile device.
6	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Set up USA ePay
7	Aug 01 2023			User: Pennye McAnulty -> Changed : Internet Percent FROM 0 TO 100
8	Aug 01 2023			User: Pennye McAnulty -> Changed : AnnualVolume FROM 0 TO 200000.00
9	Aug 01 2023			User: Pennye McAnulty -> Changed : AverageTicket FROM 0.00 TO 200.00
10	Aug 01 2023			User: Christina Sullins -> Notes: TT Patrick asking about currency conversion for sales not in U.S. funds and if USAePay would be able to handle this. Left message for Patrick to look at USAePay site for answers and that the card issuing bank takes care of conversion of currency.
11	Aug 01 2023			User: Christina Sullins -> Notes: 04/25/2016 The funding hold has been removed and $16,740.41 has been released back to the merchant. The merchant should see the funding for $16,740.41 within the next 2-3 business days. PRM case Number : 02110086
12	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Advised merchant that a transaction did go through.
13	Aug 01 2023			User: Christina Sullins -> Notes: OSM ID: 2616204 for ACH change
14	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Had password reset and emailed David the info. User name is visha_skin and temporary password is hello123

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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