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 and voided check
		var
		signed app
		pre app too large to upload

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

Invoice Number

Invoice Amount

Invoice Status

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 K J and E Stop and Go 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 31 2025		Mike Thomas	TT Karen she says when she runs a corporate card and uses the chip reader the response she gets is "reverse approved" but if she enters the card manually it goes through fine. I called Exadigm and they are escalating the issue. Leslie said she would call back with any news. I will not be here Monday so I advised Alex they may be calling.
2	Sep 17 2024		Mike Thomas	TT Karen verified a transaction
3	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Advised Karen to call phone provider as we are some comms errors on phone lines using AT&T in her area.
4	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Karan ran a transaction for $3000 Conrad from SB came and said he can not put it through bc of governmental card and that she is a convenience store and this ticket is too high. She is supposed to refund the transaction.
5	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: NX 1200 terminal 0002 TID: 76128328 S/N: 2250X16356
6	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Karaan confirmed a transaction $21.42 went through
7	Aug 01 2023			User: Emily Karawadra -> Notes: Wrong account we cancelled elavon not SB.
8	Aug 01 2023			User: Emily Karawadra -> Notes: Just requested an account cancel. refunding for $74.99
9	Aug 01 2023			User: Aimee Jones -> Changed : TO Percent FROM 0 TO 5
10	Aug 01 2023			User: Aimee Jones -> Changed : Swipe Percent FROM 0 TO 95
11	Aug 01 2023			User: Aimee Jones -> Changed : AnnualVolume FROM 0 TO 21600
12	Aug 01 2023			User: Aimee Jones -> Changed : AverageTicket FROM 0.00 TO 20

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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