Edit Merchant || Admin Panel Impact

Merchants

Docuseal Sign Back

Update Merchant

Merchant ID

Legal Name

DBA Name

Processor

Agent

Split

Is Override

Password

Status

Product Type

Received Date

Approved Date

Activation Date

Closed Date

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 *	Notes *	Status	Date	Action
Insert file...	signed app
Insert file...	var
Insert file...	pre app
Insert file...	signed app
Insert file...	business verification
Insert file...	DL

Type

Install Date

EPI/TPN

Status

Model

Purchase T.

PD Telephone

Sales Rep

Serial #

Tracking #

TID

Employee

Purchase Date

Type

Install Date

EPI/TPN

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

EPI/TPN

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 Marion County Treatment Center Accounts Delete Overrides

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 #

State incorporated in

Business Start Date

Type of Legal Entity

Business Type *

Sub Business Type *

Types of Goods Sold

Primary Transaction Type

Card Swiped

%

Card Keyed In

%

Card Present

%

Card Not Present

%

Internet

%

Moto

%

B2B

%

B2C

%

Estimated Annual Sales Visa/MC/Discover/ AMEX Sales

Estimated Monthly Visa/MC/Discover/ AMEX Sales

Average Ticket

High Ticket

Persoanl Guarantor

Telephone Order

%

Discount Method

Refund Policy

30 Days

60 Days

Other

None

Print Refund Policy On Footer
(If Yes Input Message In Notes)

Yes

No

Notes

Date

Reminder Date & Time

Employee

Notes

Sr. No.	Date	Reminder Date	Employee	Note	Created by	Updated at	Updated by	Action
1	Feb 27 2024 10:56 AM		Charlotte Groff	Received equipment and signed cancellation request back from merchant. Submitted request to SBC. Cancelling account.	Charlotte Groff	Feb 27 2024 04:58 PM		Update Delete
2	Feb 06 2024 03:26 PM		Charlotte Groff	Kim Wilson texted me and asked me to send her a cancellation form for this merchant. I emailed it to Kim's Impact email address and let her know that we can not cancel the account until we receive the equipment back.	Dee Karawadra	Feb 06 2024 09:27 PM		Update Delete
3	Oct 31 2023 12:00 AM	Oct 31 2023	Mike Thomas	TT Renee, she is not getting an internet connection, she will have her IT person check the internet and call us back.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
4	Aug 01 2023 12:00 AM			shipped replacement S80	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
5	Aug 01 2023 12:00 AM			Will not read chip cards, requested new VAR to replace	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
6	Aug 01 2023 12:00 AM			TT Merchant terminal not communicating with internet. Tried resetting the terminal but didn't work. Merchant is going to reset the router and call back if they need further assistance	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
7	Aug 01 2023 12:00 AM			TT Sarah disabled debit on PAX S80	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
8	Aug 01 2023 12:00 AM			Sarah Cook from Marion County Treatment Center called in at 10:50am returning a call from Mike, said he was trying to update her machine. Mike was on a call so I took a message and passed it to Mike as soon as he got off the phone with another customer.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
9	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Sarah need totals from Saturday 2/26/22	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
10	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Sarah had a question concerning debit....advised her to run everything as credit because of iBUXX	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
11	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Sarah walked her through setting up terminal and walked her through a transaction...all working. She also wanted to know how to settle if they wanted to settle early...gave her instructions	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
12	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: Downloaded PAX S80 shipped FedEx ground tracking number 774498643022	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
13	Aug 01 2023 12:00 AM			User: Charlotte Goff -> Notes: SBC - IBUXX; 3.95%; Pax s80; IP; Batch: 6:00pm	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
14	Aug 01 2023 12:00 AM			User: Charlotte Goff -> Changed : Internet Percent FROM 0 TO 2	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
15	Aug 01 2023 12:00 AM			User: Charlotte Goff -> Changed : Swipe Percent FROM 0 TO 98	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
16	Aug 01 2023 12:00 AM			User: Charlotte Goff -> Changed : MonthlyVolume FROM 0.00 TO 38000	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
17	Aug 01 2023 12:00 AM			User: Charlotte Goff -> Changed : AnnualVolume FROM 0 TO 450000	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
18	Aug 01 2023 12:00 AM			User: Charlotte Goff -> Changed : AverageTicket FROM 0.00 TO 16.00	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete

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

Software Or POS Integration Questions Only

POS Software Integration

Yes

No

Software Name & Version:

Pricing Provided

Statement Analysis

Quote

POS Software Publisher

Seasonal Flag

Seasonal Months

Location Type

Deposit Time Frame

Deposit Type

Network ID

MP/AP Name

RP Name

Receipt Header Message

Receipt Footer Message

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 *