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Netdeposit Merchant Application

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Netdeposit Merchant Application Total Transact Setup (For Credit Card and ACH Processing) APPLICATION INSTRUCTIONS CREDIT CARD UNDERWRITING While we will not perform a credit check for merchants that want to use our payment processing system for credit cards only, we will need to comply with our Know Your Customer, Patriot Act, Anti-Money Laundering and Anti-Terrorist Policies and perform a back ground check. This includes checking the authorized individuals SS# and Driver’s License number against a series of data bases that provide us with the necessary information. This will not affect the authorized individual’s credit. ACH, E-Check and RDC UNDERWRITING Merchants who wish to process eCheck, and/or RDC (check) payments through our payment processing system must apply for a Merchant Account by completing the following Merchant Application and submitting the application with the supplementary documentation listed below. Federal law requires that all financial services companies obtain, verify, and record information that identifies each person and business entity that opens a merchant account. The information requested will be used to process the application and will be kept confidential. ADDITIONAL DOCUMENTATION IMPORTANT Please make sure that the authorized individual’s contact information is the same person that signs the application. Please provide the following information: Authorized Individual’s Signature (please make sure that the authorized individuals contact information is the same person that signs Copy of the Authorized Individual’s Driver’s License For each bank account specified on this app, please include a copy of a voided check or bank letter that clearly identifies the bank name, account holder, routing number, and account number. Starter checks are not allowed. **Depending upon credit worthiness and length of time in business, we reserve the right to request additional information on a case-by-case scenario. PRODUCT USAGE DEFINITIONS Select the products (eCheck, Card, and/or RDC) and the features you wish to use. The features are defined as: • Virtual Terminal (VT) – Enables merchant to process telephone, mailed-in, and/or face-to-face payments. • Recurring Payments (RP) – Enables merchant to setup and manage installment or recurring payments. • Online Payment Page (OPP) – Allows merchant to accept payment from its customers via the Internet. • PayForward (PF) – Provides merchant ability to originate eCheck payments to vendors, customers, and/or employees. • API/Web Services (WS) – Enables merchants to initiate payments, manage customer payment information, and report payment status via HTTPS POST or Web Services interfaces. Appropriate for IT-savvy merchants or technology channel partners who want responsibility for the user experience. • Batch Payment Request File (BPRF) – Allows merchants to submit eCheck and Card payments using BankServ-proprietary batch file or eCheck payments using NACHA file format. Batch files can be uploaded via Web browser or SFTP. • Batch Reporting File (BPF) – Provides merchants with batch file-based reports on eCheck, Card, and RDC transactions (e.g., processed, disbursed, and returned Items). • Swipe Card Terminal (SCT) – Enables merchants to process face-to-face, card present payments. Requires a card reader. • Remote Deposit Capture (RDC) – Enables merchants to capture physical checks and electronically deposit them at BankServ. Requires a supported check scanner. Completed applications and supplemental information may be faxed to VMS at 877-885-1740 or email to [email protected] . 1 Rev111027 Total Transact Setup (For Credit Card and ACH Processing) RESELLER INFORMATION Reseller ID Reseller Name Date Sales Agent ID Sales Agent Business Phone Email COMPANY INFORMATION Company Name (EXACT Legal Name) Doing Business As (if applicable) Taxpayer ID Number Annual Sales ($000s) In Business Since (MM/YYYY) Website URL General Phone Business Street Address City State ZIP Code Billing Address (if different from above) City State ZIP Code Legal Status of Business: Corporation Partnership Limited Liability Company Sole Proprietorship Government Non-Profit Other: Description of Business or Service, Markets Served, and Types of Business Location (e.g., retail, commercial, industrial) Principal Owners (List all owners who have >20% ownership share. Attach a separate sheet if necessary.) Name and Title Business Phone Name and Title Business Phone Other Business Information (if you answer yes to any of the following please provide details. Attach a separate sheet if necessary.) Has the company and/or principal owners filed for bankruptcy or defaulted on any debts in the past 10 years? Yes No Is the account being opened or operated as an agent for other owners (including a Private Investment Company)? Yes No Does the company engage in Internet Gambling activities or transactions of any type? Yes No Does the company engage in outbound telemarketing? If “yes”, please explain how you obtain your prospect lists. Yes No AUTHORIZED CONTACT INFORMATION According to the Patriot Act, we must have an Authorized Individual that is responsible for a payment processing account. Please identify the authorized individual who can speak about this application on behalf of the company. For single proprietorships, privately-held partnerships, limited liability companies and corporations, please identify the principal owner, partner, member or corporate office. Name and Title Email Work Phone Home Address City State Zip Code Drivers License Date of Birth SS# Home Phone SIGNATURE AND AUTHORIZATION The signature below represents and warrants that: (a) the individual signing below is the authorized representative of Merchant; (b) that the information provided herein is a complete and accurate representation of Merchant’s and authorized individual’s data as of the date hereof; and (c) that the individual has read and understood the Terms and Conditions below. Additionally, I hereby authorize BankServ and its affiliates to initiate debit and credit entries to our Depository and Fee Account(s) indicated at the depository financial institution(s) named below, according to the terms stated herein. This authorization shall remain in full force and in effect until BankServ receives written notification from Merchant of any intent to terminate this account and at such time and in such manner as to afford BankServ a reasonable opportunity to act (minimum of one week). I acknowledge that the origination of ACH transactions to my account(s) must comply with the provisions of U.S. Law. I also understand that I will be liable to pay the NSF fees that will be charged by my bank in the event debits are returned. I represent and warrant that I am authorized as an authorized representative, principal owner, member, or corporate officer to execute this payment authorization for the purpose of enrolling in the BankServ Payment Processing Service. I hereby agree to indemnify and hold BankServ harmless from damage, loss, or claim resulting from all authorized actions hereunder. Signature Print Name and Title Date PERSONAL GUARANTY (If necessary) The principal owner, partner, member, or corporate officer below hereby guarantees to BankServ the full, prompt, and complete performance of Merchant and of Merchant’s obligations under this Application, including but not limited to all monetary obligations arising out of Merchant’s performance or non-performance hereunder, whether arising before or after termination of the Application, bankruptcy, or dissolution of the business. This guaranty shall not be discharged or otherwise affected by any waiver, indulgence, compromise, settlement, extension of credit, or variation of terms of this guaranty, notice of non-payment, or non-performance of a provision of an agreement by Merchant, and all other notices or demands regarding the this Application. I have read, understood, and agreed to be bound by the terms of this guaranty. As the Authorized Contact above, I HEREBY AUTHORIZE A CREDIT CHECK AND RELEASE OF ANY AND ALL INFORMATION REQUESTED BY BANKSERV AND ITS AFFILIATES. Any misrepresentation or fraudulent information provided will be the basis of default under this agreement and grounds for immediate termination. Signature Print Name and Title Date 2 Rev111027 Total Transact Setup (For Credit Card and ACH Processing) PRODUCT USAGE INFORMATION (select which services you wish to use.) Describe how you intend to use this service (Example: “Going to use Online Payment Page to accept payments from customers.”) Select the Products you wish Virtual Terminal (VT) Recurring Payments (RP) Online Payment Page (OPP) API/Web Services (WS) to use:(check all that apply) Batch Payment Request File (BPRF) Batch Reporting File (BRF) PayForward (PF) Swipe Card Terminal (SCT) ECHECK INFORMATION Transactions/Month Transaction Volume/Month ($) Ave Transaction Amount ($) Largest One-time Amount ($) Descriptor (Name to appear on customer’s bank statement. Max 16 characters) Transaction Types: PPD (prearranged consumer payments) CCD (corporate credit or debit) TEL (received via the phone) WEB (received via the Internet) Number of NSF Retries: No retries 1 retry 2 retries Notes/Instructions: CARD INFORMATION Existing Merchant Card Account – A tear sheet from the card New Merchant Card Account – A separate merchant card application processor is required to set up the merchant on the card gateway. must be completed. Cards Accepted: Visa MasterCard American Express Discover Merchant Account Type: Retail Mail/Telephone Order E-Commerce SERVICE
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