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
		voided check
		DL
		signed app
		pre app
		business verification too large to upload

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 1/31/24
SN: 2N005578

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 Gio's Villa 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	Jan 31 2024		Charlotte Groff	Cancelling account. Received old equipment back. Submitted SR 60254188 in NPCrm to cancel account on Vantiv system.
2	Jan 26 2024		Charlotte Groff	Gregory Jordan called back again today to say that he's still being billed. I told him that I was the one he spoke to on 12/5 and that I mentioned to him then that we needed the equipment back along with a cancel request in writing. He said he will send the terminal back via UPS along with a note to cancel in the box
3	Dec 05 2023		Charlotte Groff	Gregory Jordan called today to say that he had closed his business back in April and is still being billed. After researching, we have nothing in writing that he ever sent to us for cancelling his account. I did send him an email so that he could reply to it with the cancellation request in writing. I also gave him the address of where to ship the terminal back.
4	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Turned on con tactless and Push went through when automatically
5	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Peggy advised her where to find tip reports
6	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: TT Peggy turned on server prompt
7	Aug 01 2023		Mike Thomas	User: Mike Thomas -> Notes: Programmed PAX S80 and shipped FedEx 2 day delivery
8	Aug 01 2023			User: Charlotte Goff -> Notes: Vantiv - Traditional - conversion from Elavon - Pax S80; Tip Adjust - Manual Batch
9	Aug 01 2023			User: Charlotte Goff -> Changed : TO Percent FROM 0 TO 5
10	Aug 01 2023			User: Charlotte Goff -> Changed : Swipe Percent FROM 0 TO 95
11	Aug 01 2023			User: Charlotte Goff -> Changed : MonthlyVolume FROM 0.00 TO 15000
12	Aug 01 2023			User: Charlotte Goff -> Changed : AnnualVolume FROM 0 TO 180000
13	Aug 01 2023			User: Charlotte Goff -> Changed : AverageTicket FROM 0.00 TO 65.00

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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