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
		Bank Letter
		Signed App
		VAR Sheet

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

No Revup

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 Alice Hawkins 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 04 2025		Mike Thomas	TT Merchant was on Dejavoo screen had her swipe up and select DV pay app
2	Mar 21 2025		Alexander Wilkins	Merchant received Dejavoo P1, they had a few questions but otherwise they were all set.
3	Mar 21 2025		Alexander Wilkins	Spoke to Alice, Pax S80 has died. Replacing it with a Dejavoo P1. No change to pricing or fees.
4	Feb 14 2024		Alexander Wilkins	Spoke to Anna, was trying to run a void and put in incorrect password on terminal. Reset terminal and informed Anna that because the transaction was from a day prior it would have to be a return. Stated they did not have the original card, but they know how to do a return. Will run the return once they have the original card.
5	Aug 01 2023			Tt Anna was getting check Lan....reset terminal and ran a transaction...all working
6	Aug 01 2023			Received B250 back from merchant along with signage, will mail back signage as she will need for iBuxx
7	Aug 01 2023			Cancelled Swipe Simple account
8	Aug 01 2023			Shipped Pax S80
9	Aug 01 2023			Merchant has galaxy phone which does not have the swipe simple app. Downgraded back to the pax S80. Reduced monthly fee back to $19.95. Mike is going to download terminal and ship out today
10	Aug 01 2023			They decided they want Swipe Simple instead. Updated monthly fee to $29.95. Mike is preparing equipment
11	Aug 01 2023			SBC - IBUXX- 3.95% - PAX S80 - IP - Batch time 7:00pm - Tax calculation 9.75%
12	Feb 14 2023	Feb 14 2023		Tt Anna was getting check Lan....reset terminal and ran a transaction...all working
13	Feb 13 2023	Feb 13 2023		Received B250 back from merchant along with signage, will mail back signage as she will need for iBuxx
14	Feb 09 2023	Feb 09 2023		Cancelled Swipe Simple account
15	Feb 09 2023	Feb 09 2023		Shipped Pax S80
16	Feb 09 2023	Feb 09 2023		Merchant has galaxy phone which does not have the swipe simple app. Downgraded back to the pax S80. Reduced monthly fee back to $19.95. Mike is going to download terminal and ship out today
17	Feb 03 2023	Feb 03 2023		They decided they want Swipe Simple instead. Updated monthly fee to $29.95. Mike is preparing equipment
18	Jan 31 2023	Jan 31 2023		SBC - IBUXX- 3.95% - PAX S80 - IP - Batch time 7:00pm - Tax calculation 9.75%

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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