PRE-APP COVER DETAILS
Attached Required Document Checklist :
Voided check, Business Verification Document, Copy of Drivers LicenseMerchant (Business) DBA Name :
Impact TestBusiness Legal Name :
Impact PaySystemContact Name : Morgan Withee
Contact Phone Number : 9016924540
Physical Address :
10080 Highway 194City : Oakland
State : TN
Country : United States
Zip : 38060
Phone Number :
Fax Number :
Email Address : morgan@impactpays.com
Website :
Billing Address
Address :
10080 Highway 194City : Oakland
State : TN
Country : United States
Zip : 38060
Business Type
State incorporated in : Public
Type of Legal Entity : Sole Proprietor
Business Type :
Business Start Date : -
EIN/Federal Tax ID Type :
EIN/Federal Tax ID# :
Types of Goods Sold :
Ownership Information
Owner 1
Officer/Owners Name :
Morgan WitheeTitle : Owner
Social Security : 123456789
Home Address :
1164 Vickery LaneCity : Cordova
State : Tennessee
Country : United States
Zip : 38016
Drivers License : 1234567899
Expiration Date : Oct, 17 2023
State : TN
DOB : Sep, 02 1994
Home Phone Number : 9016924540
% of Business Owned : 100
Length of Ownership : 10
Banking Information
Billing Type :
Name of Bank : FTB
ABA Routing : 111111111
Account : 0987654321
Estimated Sales Volume
Estimated Annual Sales Visa/MC/Discover/ AMEX Sales :
$100000Estimated Monthly Visa/MC/Discover/ AMEX Sales :
$10000Average Ticket :
$1000high Ticket :
$5000Business Profile
Card Swiped :
95%Card Keyed In :
5%= 100%
Card Present :
95%Card Not Present :
5%= 100%
MOTO :
0%Internet :
0%IBUXX
Notes :
Terminal Answer
Batch Out Time : 11:00 AM
Terminal Type : 7
Communication Method : IP-internet
Do You Dial 9 For Outside Line? : Yes
Reprogram Terminal : Yes
Equipment Purchase : No
Equipment Rental Program : No
Next Day Funding : No
Tip Edit : No
EBT : No
FNS Number :
Tax Calculation : No
If So Tax Rate :
Refund Policy :
Print Refund Policy On Footer : No
Software Or POS Integration Answer
POS Software Integration :
Software Name & Version :
MP/AP Name :
RP Name :
Pricing Provided :
Receipt Header Message :
Receipt Footer Message :
Front Drivers License Download
Back Drivers License Download
Voided Check Download