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
		DL and Voided Check
		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

reprogram existing terminal used in traditional pricing

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 Gregory E. Reeves O.D. 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		Alexander Wilkins	Spoke to Sabrina, terminal did not have Amount Confirmation Screen on so it was not allowing them to Bypass. Turned it on and updated terminal. Tested and merchant successfully Bypassed.
2	Aug 01 2023			TT Cathy, needed to know how to run a refund
3	Aug 01 2023			Turn on manual entry for debit on insurance cards
4	Aug 01 2023			TT Cathy advised her how to bypass fee on insurance cards
5	Aug 01 2023			Shipped 3.50 signage
6	Aug 01 2023			TT Cathy unsupported card on insurance cards...turned on manual entry, now working
7	Aug 01 2023			Downloaded terminal for iBuxx 3.5
8	Aug 01 2023			Added MID and approval date - updated status to Approved. Uploaded signed application and var sheet for IBUXX.
9	Aug 01 2023			SBC - IBUXX - 3.5% - switched from traditional - Valor VL100 - reprogram terminal used in traditional processing.
10	Jul 06 2023	Jul 06 2023	Mike Thomas	TT Cathy, needed to know how to run a refund
11	May 02 2023	May 02 2023	Mike Thomas	Turn on manual entry for debit on insurance cards
12	May 01 2023	May 01 2023	Mike Thomas	TT Cathy advised her how to bypass fee on insurance cards
13	May 01 0203	May 01 2023	Mike Thomas	Shipped 3.50 signage
14	May 01 2023	May 01 2023	Mike Thomas	TT Cathy unsupported card on insurance cards...turned on manual entry, now working
15	Apr 26 2023	Oct 26 2023	Mike Thomas	Downloaded terminal for iBuxx 3.5
16	Apr 24 2023	Apr 24 2023	Charlotte Groff	Added MID and approval date - updated status to Approved. Uploaded signed application and var sheet for IBUXX.
17	Apr 21 2023	Apr 21 2023	Charlotte Groff	SBC - IBUXX - 3.5% - switched from traditional - Valor VL100 - reprogram terminal used in traditional processing.

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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