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
		signed app
		pre app
		var
		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

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 Minor Johnston Douglas PLLC 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 07 2025		Charlotte Groff	Updated banking information and submitted request to SBC for updating in their system.
2	Jan 06 2025		Charlotte Groff	merchant needs to update banking information. Emailed them the bank account change form.
3	Jun 27 2024		Charlotte Groff	Courtney called in and said that when they issued the refund for the duplicate charge for card 9124 from 6/5/24 mentioned below that they only refunded the amount that they were billing the customer which was $800.00. They did not refund the cash discount fee of $31.60. Per Emily, requested a refund to the merchant for $31.60 and told Courtney to issue a refund to the cardholder for $31.60 and she should see the refund to her in tomorrow's batch.
4	Jun 14 2024		Charlotte Groff	Stacy called in regarding a transaction that they originally took on 6/5/24 for $831.60 on card 9124. The transaction did batch and was paid out on 6/6/24. Mysteriously it also appeared in her batch from 6/12/24 and was paid out on 6/13/24 which resulted in the cardholder being billed again. When I looked in Pioneer, the transaction does show in each batch from 6/5 & 6/12 and the merchant was paid both times. However, when I check the transactions search, it only appears once with a trans date of 6/5 and a batch date of 6/12. When Stacy looked at her batch report from the terminal for 6/12, the $831.60 transaction was no on there.
5	Oct 10 2023		Charlotte Groff	Spoke to Courtney. She had questions about PCI and could not get logged into the PCI website. I gave her the phone number for PCI and all of the information she would need.
6	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Stacy questions concerning paper for the NX1200
7	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: NX1200 Terminal 0002 TID: 76160724 S/N: 9033X16355
8	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Linda from Secure Bancard called this morning with Taylor on the line. Taylor let me know that she was not able to run American Express cards and was getting the error invalid input. Taylor stated that she called Exadigm who told her it was not a terminal issue and they sent her to stays. Tsys said they see no issue because they cant see the transaction coming through. So Tsys sent her to Linda and Linda looked over the account and shows that they are set up for American Express and that their should be no issues. She reiterated that she can not see the transaction in the system which means it is not leaving the terminal. I told Taylor I would research the issue and get back with her. I spoke with Dee and he told me to get another terminal downloaded and go drop it and then bring the other one back so we can figure out what happened with it.
9	Aug 01 2023		Morgan Withee	User: Morgan Withee -> Notes: Portal password: MJD2020!!
10	Aug 01 2023			User: Kay Arpin -> Changed : TO Percent FROM 0 TO 70
11	Aug 01 2023			User: Kay Arpin -> Changed : Swipe Percent FROM 0 TO 30
12	Aug 01 2023			User: Kay Arpin -> Changed : MonthlyVolume FROM 0.00 TO 15500
13	Aug 01 2023			User: Kay Arpin -> Changed : AnnualVolume FROM 0 TO 186000
14	Aug 01 2023			User: Kay Arpin -> Changed : AverageTicket FROM 0.00 TO 500

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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