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
		var 1
		var 2
		var 3
		var 4
		voided check
		pre app
		dl
		business verification
		signed app

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

Batch Time 7:00pm - IP
SN: 118213111848

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

SN: 118213111849

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

Type

Install Date

Equipment ID

Status

Model

Purchase T.

PD Telephone

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Replacement for tampered terminal

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 Jaya L Dental Arts 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	Apr 29 2025		Charlotte Groff	submitted request to GEM team to have both MIDs linked together for PCI Compliance purposes. SR 62327980 - Allow 5 days to be completed. This MID is the MASTER MID
2	Apr 10 2025		Alexander Wilkins	Sent in application for Website, awaiting approval to add second MID
3	Apr 08 2025		Alexander Wilkins	Spoke to Erica and tried some troubleshooting steps. We had to have her turn on the Hotspot on her phone, connect it to the terminal, and redownload the RKI Keys. We then switched it over to Wifi and ran a test transaction that went through successfully.
4	Apr 07 2025		Charlotte Groff	Erica called and said they just received the VL100Pro terminal and it's saying RKI Failed. I called Valor and spoke with Rich and he tried a few things on the terminal and again it got an RKI Failed. He said he would need to escalate the issue to developers/engineers and he would call Erica back. I asked Erica to let me know if he does not call her back.
5	Apr 01 2025		Mike Thomas	TT Brittany VL100 has "tampered" must replace
6	Sep 05 2024		Charlotte Groff	Spoke to Brittany regarding the Valor payment link on their website. She said that it's not letting customers make a payment. I asked her to try a payment while I was on phone with her to see if there is any sort of error. She said that when she clicks on the link it takes her to a screen that asks for a username and password. She's checking with her web developer to see if it's site related and we are checking with Valor to make sure the link is still viable
7	Aug 29 2024		Mike Thomas	Update terminal and VT to WP
8	Jul 12 2024		Mike Thomas	Helped Brittany with an expired Payment Link through Valor
9	Feb 21 2024		Charlotte Groff	Submitted request to GEM team to have merchant opted out of RAAP per email from Emily. SR 60386504
10	Nov 27 2023		Charlotte Groff	Merchant called and needed to know what his fees that he paid for October were.
11	Aug 31 2023	Aug 31 2023	Mike Thomas	Called Valor to see why merchant is not receiving emails on paylink transactions...notifications were turned off they turned them back on, Calling Brittany to show her how to view all the transactions.
12	Aug 31 2023	Aug 31 2023	Mike Thomas	*This is our log in credentials to act as merchant Username: [email protected] Password: Memphis22$$**
13	Aug 01 2023			User: Charlotte Goff -> Notes: Changed status to Approved; uploaded 2 Var sheets; added MID and approval date
14	Aug 01 2023			User: Charlotte Goff -> Notes: Vantiv - Traditional - IC + 0.10% + $0.08; 2 Valor Terminals - Batch 7:00pm
15	Aug 01 2023			User: Charlotte Goff -> Changed : TO Percent FROM 0 TO 25
16	Aug 01 2023			User: Charlotte Goff -> Changed : Swipe Percent FROM 0 TO 75
17	Aug 01 2023			User: Charlotte Goff -> Changed : MonthlyVolume FROM 0.00 TO 116392
18	Aug 01 2023			User: Charlotte Goff -> Changed : AnnualVolume FROM 0 TO 2046135
19	Aug 01 2023			User: Charlotte Goff -> 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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