Merchants

Back

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

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 Evolution Vision Care 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 16 2024		Charlotte Groff	spoke to Ush. He said that he received a debit in January for December fees and he had requested his account to be closed in October. I confirmed in NPCrm that this location only was still open. The other 2 had been closed already. I submitted SR60123356 to close the location and also sent a request to have merchant issued a refund for $33.40 for December fees. Refund is to be deducted from our residuals. I received confirmation that SR# 60127918 has been submitted from Vantiv for the refund. It takes up to 7 days for the refund to be processed.
2	Oct 05 2023	Oct 18 2023	Morgan Withee	spoke to Ush - he is closing down both of his locations. I told him to send me an email so I have something in writing to close out his accounts. The last day of processing will be on 10/16/23. I told him that we will close this out and the last bill he will see will be for the month of october which will come out the first week of november.
3	Aug 01 2023			User: Charlotte Goff -> Notes: Changed status to Approved entered MID and approval date
4	Aug 01 2023			User: Charlotte Goff -> Notes: VANTIV - Tradtional - IC + 0.10% = $0.10; Pax A920 Reprogram; Batch Time: 5:00 pm - This merchant was previously set up but shut her office down while on Maternity leave. When she called into re-open Vantiv could not simply re-activate her account because it had been too long.
5	Aug 01 2023			User: Charlotte Goff -> Changed : Internet Percent FROM 0 TO
6	Aug 01 2023			User: Charlotte Goff -> Changed : Swipe Percent FROM 0 TO 100
7	Aug 01 2023			User: Charlotte Goff -> Changed : MonthlyVolume FROM 0.00 TO 12000
8	Aug 01 2023			User: Charlotte Goff -> Changed : AnnualVolume FROM 0 TO 120000
9	Aug 01 2023			User: Charlotte Goff -> Changed : AverageTicket FROM 0.00 TO 150.00

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 *

Cancel