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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
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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

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 Jonesboro Diesel and Trailer 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 #

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	Aug 01 2023 12:00 AM		Morgan Withee	User: Morgan Withee -> Notes: Put in SR to close out this account. Attached the cancelation request in documents	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
2	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Ken wanted to know info about iBuxx trans to Morgan	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
3	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Ken gave him pricing on USAePay dongles...he will let me know what kind of phone he has and what type connection he needs.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
4	Aug 01 2023 12:00 AM			User: Cheri Hansen -> Notes: Need DL EIN and maybe a voided check (new ACH change in docs)	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
5	Aug 01 2023 12:00 AM		Morgan Withee	User: Morgan Withee -> Notes: TT Ken he was a little cranky abou this PCI non copmpliance fee. I let him know once he gets compliant I can get him a one time goodwill refund. I am emailing them the directions so they can get it completed.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
6	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Ken walked him through processing a refund	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
7	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Ken gave him Elavon PCI helpdesk phone number	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
8	Aug 01 2023 12:00 AM			User: Emily Karawadra -> Notes: spoke to owners wife let her know to try again in 24 hours also sent her instructions for pci	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
9	Aug 01 2023 12:00 AM			User: Emily Karawadra -> Notes: Wife called in to get their email chaned in the system. Called Elavon got it changed to jonesborodieselandtrailer@hotmail.com They told me allow it 24 hours to take effect in the system	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
10	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Ken, verified a transaction of $108.50 went through on 8/23/19	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
11	Aug 01 2023 12:00 AM			User: Pennye McAnulty -> Notes: PCI username Diesel01 and Fishing01.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
12	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Ken, system error had him power cycle terminal....now working.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
13	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: TT Ken, walked him through a void	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
14	Aug 01 2023 12:00 AM			User: Pennye McAnulty -> Notes: User name Jonesboro01 Password is Diesel01	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
15	Aug 01 2023 12:00 AM			User: Pennye McAnulty -> Notes: tt Ken he was missing a payment the terminal did not settle until after midnight. We conferenced in Elavon and changed the auto settle time to 5:00.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
16	Aug 01 2023 12:00 AM			User: Pennye McAnulty -> Notes: tt Ken conference with Elavon terminal getting error message of remote download failed.	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
17	Aug 01 2023 12:00 AM			User: Pennye McAnulty -> Notes: Send correction for ach # to Elavon	Dee Karawadra	Jan 31 2024 01:39 PM		Update Delete
18	Aug 01 2023 12:00 AM		Mike Thomas	User: Mike Thomas -> Notes: Downloaded iCT220 SN 2216056CT010395 dial	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 *