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
		pre app
		app
		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

Returned SN: 332-913-888

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 Smithville Quick Stop 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	Dec 12 2024	Dec 12 2024 12:00am	Charlotte Groff	Test Bank account change needed TEST - merchant needs bank account change
2	May 07 2024		Mike Thomas	TT Mahraan called and was upset he was billed again as in a previous call I advised him April statement would be his last billing.
3	Apr 16 2024		Mike Thomas	TT Mahraan and confirmed we received the equipment back. Advised him he would receive one more statement for April.
4	Apr 15 2024			Received equipment back. Submitted SR 60722860 to WorldPay to cancel the account.
5	Apr 09 2024		Charlotte Groff	Mahraan called wanting to know his fees for the last 3 months. I pulled his statements and gave his fee, then he said he needs to cancel his account because he's not using the terminal anymore. I told him we would need something in writing and also the terminal to be shipped back. They will ship the terminal back to us with the cancel letter in the box.
6	Aug 29 2023		Charlotte Groff	emailed W-9 to merchant (Adam Hasson) for WorldPay to match up IRS data.
7	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Downloaded VX520 with EBT, Debit no EMV SN: 332-913-888
8	Aug 01 2023			User: Pennye McAnulty -> Notes: Wants to be set up with EBT. EBT #0664783 Adam will email his EBT approval letter.
9	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Had file changed to dial, will change through terminal with Bethany.
10	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Download VX520 IP no EMV SN: 803-225-356
11	Aug 01 2023			User: Pennye McAnulty -> Changed : MO Percent FROM 0 TO 5
12	Aug 01 2023			User: Pennye McAnulty -> Changed : Swipe Percent FROM 0 TO 95
13	Aug 01 2023			User: Pennye McAnulty -> Changed : MonthlyVolume FROM 0.00 TO 250
14	Aug 01 2023			User: Pennye McAnulty -> Changed : AnnualVolume FROM 0 TO 360000
15	Aug 01 2023			User: Pennye McAnulty -> Changed : AverageTicket FROM 0.00 TO 50.00

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 *

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