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
		business license
		DL
		pre app
		var
		signed app
		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

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 L & R Patel Inc 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	May 28 2025		Charlotte Groff	Received an email from SBC about a fraud chargeback for $1209.69 on May 18th transaction date. SBC wanted me to educate the merchant on manually keying in transactions. I called the merchant. The owner is out of town on vacation, but I spoke to Misty, the store manager. She is aware of the risks involved in keying in a card number and said that she never keys in a card number for a transaction, but she is thinking that it could possibly be that the incorrect amount was entered on the terminal. She's searching for the transaction now. I did reiterate the risks of keying in card numbers and she understands that because it is manually keyed entered that they will lose that chargeback.
2	Jan 27 2025		Mike Thomas	TT KIM helped her connect new pin pad and walked her through a test...all working
3	Jan 21 2025			replaced Valor 300 PP
4	Sep 27 2024		Mike Thomas	KIm text me with pictures of an error message on Valor> I advised her Valor was down . After hours 9/7/24 in the a.m
5	Jul 08 2024		Charlotte Groff	account was showing cancelled for unknown reason. They were still processing transactions and are still active on SBC. Reactivated account.
6	Oct 18 2023		Charlotte Groff	This merchant was involved in the MC Rejects that occurred 10/12 - 10/14 on SBC. I called him today to let him know that he had some rejected transactions and that they would be paid as soon as the issue gets resolved. When I called his cell phone, it went straight to voicemail, so I left a message giving him some details and asking him to call the office.
7	Sep 05 2023		Charlotte Groff	Emily spoke to "Danny" and sent him his monthly statement. I emailed him the Pioneer QRG with instructions on what to do to get registered so that he can pull his monthly statements each month.
8	Aug 01 2023			On Saturday 5/27 we had to reset daily threshold
9	Aug 01 2023			TT Dinesh, pin pad was not powering up we did an application download. Now working
10	Aug 01 2023			SBC- IBUXX- 3.5%- Valor 100- IP- Batch Time 11:30pm Central- wants Apple pay

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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