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
		Driver's License
		Voided Check
		Business License

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

SN: 118234715114 ***RETURNED***

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

Merchant does Not have RevUp....they have just a P1 terminal so that they can run refunds on their HSA cards they process.

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 Southern Vision Eye Care LLC 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	Mar 14 2025		Charlotte Groff	received email from molly to cancel this MID. I submitted the request to WP - iso_support email address. SR#62127388 - WP said it should close out tonight.
2	Mar 03 2025		Charlotte Groff	Called Jennifer and asked her to get Molly to send us a letter stating that she needs to close this MID. Told her to make sure to inlcude MID and Tax ID number.
3	Feb 19 2025		Charlotte Groff	Jennifer sent an email saying the merchant wants to switch to IBUXX beginning 3/1/25. Filled out the application and sent it for signature so we can get their IBUXX account set up and approved prior to 3/1/25
4	Jan 23 2025		Mike Thomas	Received VL100 back. Placed in inventory and deactivated in Valor
5	Jan 08 2025		Charlotte Groff	Sent merchant a new Dejavoo P1 terminal so that they can run the HSA refunds themselves. Return label for the Valor was in the box with the new terminal. Called Tracy at merchant's location to let them know the terminal was on it's way.
6	Jan 07 2025		Charlotte Groff	Spoke to Tracy - they needed to refund 2 more patients that have the HSA cards. Card 8204 for $120.00 and also card 0839 for $142.50. Emailed refund receipts and batch receipt to merchant.
7	Dec 12 2024		Alexander Wilkins	Merchant needed 319 refunded on Flex Spending Card. Unable to be done on Valor. Used Dejavoo Terminal and successfully refunded the 319. Merchant was emailed receipt showing successful refund.
8	Dec 10 2024		Alexander Wilkins	Merchant had a Flex Spending Card used on their Valor. Customer needed a refund and the Valor started that it cannot run refunds for Prepaid Cards.
9	Dec 04 2024		Charlotte Groff	Linda called and said that they ran a transaction on 12/3/24 for $294.80 on card 8315. The cardholder is stating that their bank is showing 3 charges to their account. I checked IQ and could only see one authorization and one settlement record. I suggested to have the customer call their bank and see if their bank will apply those other 2 sales back to their credit available. I sent Linda a screenshot of IQ showing the one auth and the one settlement record.
10	Aug 28 2024		Mike Thomas	Updated terminal to WP
11	Apr 25 2024		Alexander Wilkins	Vantiv - Traditional - Valor 100 - IP - Batch Time : 7PM

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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