Retailer Information Center
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Business Information
Business Structure:
Corporation
LLC
Partnership
Sole Proprietorship
Non Profit
Services:
Card Processing
EBT
Legal Business Name:
DBA Name:
FTID:
MID:
EBT:
Business Type:
Business MCC:
Legal Business Address:
City:
State:
Zip:
DBA Address:
Business Tel.Number:
Fax Number:
Business Email Address:
Business Open date:
Business Hours Operation:
Bank Information
Bank Name:
Bank Address:
Bank City:
Bank State:
ZIP:
Routing Number:
Account Number:
Business
Photo:
Change
Owner Name:
Percentage Owned:
Home Address:
City:
State:
Zip:
Tel:
Fax:
Email Address:
Birthday:
Social Security Number:
TIN:
Driving License Number:
Exp Date:
Title:
CEO
COO
CFO
LLC Member
Partner
President
Secretary
Treasurer
Vice President
Additional Owners
Photo:
Change
Owner Name:
Percentage Owned:
Home Address:
City:
State:
Zip:
Tel:
Fax:
Email Address:
Birthday:
Social Security Number:
TIN:
Driving License Number:
Exp Date:
Title:
CEO
COO
CFO
LLC Member
Partner
President
Secretary
Treasurer
Vice President
Photo:
Change
Owner Name:
Percentage Owned:
Home Address:
City:
State:
Zip:
Tel:
Fax:
Email Address:
Birthday:
Social Security Number:
TIN:
Driving License Number:
Exp Date:
Title:
CEO
COO
CFO
LLC Member
Partner
President
Secretary
Treasurer
Vice President
Notes
Third Party Processor
Third Party Enable:
OFF
ON
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TTName:
TPP Email Address:
TPP Phone Number:
MERCHANT SERVICES
Payment Accepted:
VISA
Master Card
Discover
EBT
AMX
PIN DEBIT
AMX Opt Blue
AMX Esa
AMX Esa SE
Discover Full ACQ
Discover EASI
DIACOVER EASI SE
Discover Enable Incremental Authorization
Discover Repayment Program
Discount Frequency:
Monthly
Yearly
Net Fees and Deposits
Separate Fees and Deposits
Individual Batches
MERCHANT PROGRAM/SURCHARGE
Visa Discount Fee:
%
Master Card Discount Fee:
%
Discover Card Discount Fee:
%
AMX Card Discount Fee:
%
Debit Card Discount Fee:
%
Consumer Surcharge Rate Billed by Merchant:
%
Debit Card Transaction FEE :
$/ Per Transaction
Bill Back
Non qualified surcharge fee (including interchange pass-through fees)
Discount Rate
Credit
Non-Pin Debit
Visa
%
%
MasterCard
%
%
Discover
%
%
AMX
%
%
MERCHANT PROGRAM/TIERED
Discount Rate
Credit
Non-Pin Debit
Visa
%
%
Visa Mid
%
%
Visa Non
%
%
Mastercard
%
%
Mastercard Mid
%
%
Master Non
%
%
Discover
%
%
Discover Mid
%
%
Discover Non
%
%
AMX
%
%
AMX Mid
%
%
AMX Non
%
%
MERCHANT PROGRAM/INTERCHANGE
Pass through interchange:
Gross Interchange
Net Interchange
Pass through interchange: Merchant will be charged the applicable interchange rate from MasterCard, Visa, Discover and American Express as well as the discount rate listed below. Interchange rates are variable and are determined by how the transaction is cleared, and are subject to change.
Discount Rate
Credit
Non-Pin Debit
Visa
%
%
MasterCard
%
%
Discover
%
%
AMX
%
%
MERCHANT PROGRAM/FLAT RATE
Discount Rate
Credit
Non-Pin Debit
Visa
%
%
MasterCard
%
%
Discover
%
%
AMX
%
%
MERCHANT PROGRAM/GATEWAY FEES
Setup Fees:
Englobe Platform Fee:
EBT Gateway Fee:
Other Gateway Fee:
Name:
Gateway Transaction Fee:
MERCHANT PROGRAM/PIN DEBIT
Discount Fee:
Transaction:
Debit Gateway Fee:
MERCHANT PROGRAM/EBT/SNAP
FNS:
Transaction Fee:
FUEL:
Discount Fee:
Transaction Fee:
Chargeback Fee:
Data Protection Fee:
Retrieval Fee:
MERCHANT PROGRAM/Monthly and Miscellaneous Fees
Application Fee:
Minimum Processing Fee:
DDA Reject:
Statement Fee:
Chargeback Fee:
Retrieval Fee:
Annual Security Bundle Fee:
Regulatory Product Fee:
PCI-Non Compliant Fee:
Wireless Transaction Fee:
Wireless Monthly Fee:
Wireless Activation Fee:
PCI Annual Fee:
PCI Concierge Monthly Fee:
NSF Fee:
Voice Authorization Fee:
Batch Header Fee:
Annual Account Fee:
Paypal Network Fee:
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