PRE-APP COVER DETAILS

Created On Sep, 20 2024 16:10pm   ID #7829 Back Download Add Merchant Resend Document for Sign

Attached Required Document Checklist :

-

Merchant (Business) DBA Name :

Impact Tech Lab

Business Legal Name :

Impact Tech Lab

Contact Name : Deepak Karawadra

Contact Phone Number : 9016010032

Physical Address :

1164 Vickery Lane suite 200, Cordova, TN, USA

City : Cordova

State : TN

Country : USA

Zip : 38016

Phone Number : 9016010032

Fax Number :

Email Address : dee@impactpays.com

Website :

Billing Address

Address :

1164 Vickery Lane suite 200, Cordova, TN, USA

City : Cordova

State : TN

Country : USA

Zip : 38016

Business Type

State incorporated in : Public

Type of Legal Entity : LLC

Business Type : Retail

Business Start Date : Jun, 01 2021

EIN/Federal Tax ID Type : Employer Identification Number

EIN/Federal Tax ID# : 931934226

Types of Goods Sold : software

Ownership Information

Owner 1

Officer/Owners Name :

Deepak Karawadra

Title : Owner

Social Security : 408598387

Home Address :

10080 Highway 194

City : Oakland

State : TN

Country : US

Zip : 38060

Drivers License : 070525101

Expiration Date : Feb, 28 2026

State : TN

DOB : Jan, 10 1973

Home Phone Number : 9018282229

% of Business Owned : 100

Length of Ownership :

Banking Information

Billing Type : Gross Settlement

Name of Bank : First Horizon

ABA Routing : 084000026

Account : 173272303

Estimated Sales Volume

Estimated Annual Sales Visa/MC/Discover/ AMEX Sales :

$100000

Estimated Monthly Visa/MC/Discover/ AMEX Sales :

$10000

Average Ticket :

$1000

high Ticket :

$9000

Business Profile

Card Swiped :

0%

Card Keyed In :

100%

= 100%

Card Present :

0%

Card Not Present :

100%

= 100%

MOTO :

100%

Internet :

0%

Traditional

Notes :

Terminal Answer

Batch Out Time : 11:00 AM

Terminal Type : VT Valor

Communication Method : IP-internet

Do You Dial 9 For Outside Line? : Yes

Reprogram Terminal : No

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 : None

Print Refund Policy On Footer : No

Software Or POS Integration Answer

POS Software Integration : No

Software Name & Version : Valor VT

MP/AP Name :

RP Name : 9999914616

Pricing Provided :

Receipt Header Message :

Receipt Footer Message :

Front Drivers License Download

Front

Back Drivers License Download

Front

Voided Check Download

Front

Business Document 1 Download

Front