Required Document Checklist Copy of Voided Check where funds will be deposited and fees withdrawn
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- Milton Watson
- 8 years ago
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1 Greetings! Welcome to the Frazer Computing s electronic payment program. Provided in partnership with Frontstream Payments, this program will enable your dealership to accept credit card and check payments directly through the Frazer Auto Dealership software. Below is a list of all requirements for your application. The following pages include: 1) Frazer Program Pricing 2) Merchant Account Application 3) ACH Enrollment form 4) ACH Service Addendum Required Document Checklist Copy of Voided Check where funds will be deposited and fees withdrawn For Currently Processing Merchants We Will Also Require: Existing American Express merchant establishment number Please complete, initial, and sign where indicated and gather all necessary documents. Then fax back to (866) ; attention VAR Sales. If you prefer, you may scan and them to frazerapps@frontstreampayments.com. Your account will be approved within hours of receiving your complete application package. If you have questions or need assistance with the paperwork, please contact us via or phone. Frontstream Payments looks forward to exceeding your expectations. Best Regards, Stephanie Wagner National Account Executive Frontstream Payments (P) x229 (F) Stephanie.wagner@frontstreampayments.com
2 Merchant Application Winners Circle North, Suite 158 Nashville, TN Business Legal Name: Legal Address: Business Information Business DBA: DBA Address: (No P.O. Boxes) Legal City: State: Zip: DBA City: State: Zip Legal Phone: Legal Fax: Contact Name: DBA Phone: DBA Fax: Contact Tax ID: Business Start Date: (mm/dd/yyyy) / / Single Location Additional Location Existing MID #: Multi Locations of total Locations Corporate Headquarters URL: www. Length of Ownership: Years Send To: Legal DBA DBA Ownership Type: Address Address Fax Sole Proprietorship Statements NA Partnership Chargebacks NA Corporation Retrieval Requests Medical/Legal Principal/Ownership #1 Owner Name: #2 Owner Name: Months Non-Profit LLC Government Association/Trust Title: Percent of Ownership Title: Percent of Ownership DOB (mm/dd/yyyy): / / Home Address: SSN #: DOB (mm/dd/yyyy): / / Home Address: SSN #: City: State: Zip: City: State: Zip: Home Phone: Cell Phone: Home Phone: Cell Phone: Drivers License Number: State: Drivers License Number: State: Address: Address: Member Bank: First National Bank of Omaha 1620 Dodge St. Omaha, NE IMPORTANT MERCHANT RESPONSIBILITIES 1. Ensure Compliance with cardholder data security and storage requirements. 2. Maintain fraud and chargebacks below thresholds. 3. Review and understand the terms of the Merchant Agreement. 4. Comply with Visa Operating Regulations. Merchant Name: Address: Important Disclosure IMPORTANT MEMBER BANK RESPONSIBILITIES 1. A Visa Member is the only entity approved to extend acceptance of Visa products directly to a Merchant. 2. A Visa Member must be a principal (signer) to the Merchant agreement. 3. The Visa Member is responsible for educating Merchants on Pertinent Visa Operating Regulations with which Merchants must comply. 4. The Visa Member is responsible for and must provide settlement funds to the Merchant. 5. The Visa Member is responsible for all funds held in reserve that are derived from settlement. The responsibilities listed above do not supersede the terms of the Merchant Agreement and are provided to ensure the Merchant understands some important obligations of each party and that the Visa Member (Acquirer) is the ultimate Authority should the merchant have any problems. X / / Signature of Authorized Signer Printed Name: Version FrontStream Payments is a registered ISO/MSP of First National Bank of Omaha, Omaha, NE Page 1 of 4 FNBO 1620 Dodge St Omaha, NE
3 Bank Name: Financial Information Contact Name: Address: Phone #: City: State: Zip: Account Type: Checking Transit Routing #: Bank Account #: Savings Is the account with FNBO? Yes No Funds Transfer: In accordance with the terms set out in the Terms and Conditions, transfer of funds will be made to/from the account set forth in the enclosed voided check or bank letter. A PRE-PRINTED VOIDED CHECK OR BANK LETTER MUST ACCOMPANY THIS APPLICATION Trade References #1 Business Name: #2 Business Name: Contact Name: Contact Name: Phone #: Phone #: Expected Monthly Bank Card Sales: $ Expected Annual Bank Card Sales: $ Business Profile Bank Card Average Ticket: $ Bank Card Highest Ticket: $ Type of business: Retail Restaurant Travel & Entertainment CNP ecommerce Supermarket CNP/Retail Type of Goods/Services Sold: What is your return or refund policy? Card Acceptance Card Present: % Card Not Present: % ecommerce with % Shopping Cart: Do you operate as a Seasonal Merchant? Detailed Description of Business: Do you currently have a merchant processing account? Reason for changing Merchant Processor? Has any principal of your business had processing services terminated? Breakdown of Card Present (%) Card Swipe: % (%) Non-Card % Swipe: Customer Profile Direct-To- Consumers Sales: % Business-to Business Sales: % Total = 100% If YES, indicate operating months: Card Not Present/eCommerce When is Credit Card Charged: Time of Sale Ship Delivery Number of Days Date Date Until Delivery: Goods are shipped from: Yes No Previous Credit Card Processing History Does Merchant Do Recurring Billing? Yes No Geographic Profile Domestic Sales: % International Sales: % Total = 100% Jan Feb Mar Apr May Jun J ul Aug Sep Oct Nov Dec How are goods/services delivered: Customer US Download Pick-Up Postal Door-to-Door Parcel Other: Delivery Carrier DBA Manufacturer Fulfillment Other: House: Yes* No Current *If YES, please provide 3 months processing Processor: statements from your Current Processor Lower Service Reason Other: Rates Problems Unknown Yes No If YES, explain: Have you or the business ever declared bankruptcy? Yes No If yes, please provide date and whether owner or business: Version FrontStream Payments is a registered ISO/MSP of First National Bank of Omaha, Omaha, NE Page 2 of 4 FNBO 1620 Dodge St Omaha, NE
4 PCI Compliance Terminal (check all that apply) Internet Point of Sale IP Terminal Model PIN Debit Device Model Dial Up Terminal Model Wireless Terminal Model Card Imprinter Dial Pay Transactions processed through Internet Website Host Shopping Cart Host Payment Gateway Transactions processed using a Point of Sale system Product Vendor Product Application Product Version Do you contract with any other third parties that store, process, transmit or have access to credit card data on your behalf? If yes, please provide name(s) and contact information. Yes No To maintain PCI Compliance of your merchant account, standards are to be upheld at all times. Accurately providing the above information will aid in the PCI management of your account. Card Present Retail Retail Supermarket CNP Card Not Present CNP Recurring CNP ecommerce Setup Fees: Application Fee: Reprogram Fee: Terminal Fee: IP Terminal Setup Fee: ARU Retail Retail Supermarket T & E T&E/Restaurant T&E/Hotel T&E/Car Rental (One Time Fees) $ $ $ $ Gateway Fees: Gateway Name: Activation/License Fee: $ Monthly Fee: $ Per Transaction Fee: $ Fees Visa / MasterCard / Discover Discount Check Card: % Per Item Qualified: % Per Item Rewards: % Per Item Mid Qualified: % Per Item Non Qualified: % Per Item *Please review the rate descriptions in your Terms and Conditions for additional information. Interchange Pass Thru: IPT + % Transaction fees: Per Authorization Per Item Per Authorization Per Item Visa/MC JCB Discover EBT AMEX PIN Debit (plus network fees) Recurring Fees: Monthly Statement Fee: $ Monthly PCI Fee: $ Monthly Debit Fee: $ Monthly Minimum: $ Regulatory Fee: $ IP Terminal Monthly Fee: $ Annual Fee: $ (see Terms and Conditions for further details on Annual Fee) Wireless Services: Provider: Activation Fee: $ Monthly Fee: $ Per Transaction Fee: $ Account Fees: Online Reporting: Batch Fee: Chargeback Fee: Retrieval Fee: Voice AVS Fee: Voice Auth Fee: Other: ( Fees are Per Occurrence) Other: Provider: Activation Fee: Monthly Fee: Per Transaction Fee: If the Agreement is terminated early either during the Initial Term or any Renewal Term, Merchant agrees to pay FSP an early termination fee ("Early Termination Fee") as outlined below. Merchant agrees that the Early Termination Fee is a compensatory payment and is a reasonable estimation of the damages which FSP would suffer if FSP were to fail to receive the processing business for the Initial Term or Renewal Term. The Early Termination Fee amount shall be calculated as follows: the greater of either: A) the average net monthly fees excluding Association interchange, dues and assessments, multiplied by the number of months, including any pro rata portion of a month, remaining on the then existing term multiplied by 85% or B) $395. Merchant agrees that the Early Termination Fee shall also be due if Merchant discontinues submitting Sales for processing during the Initial Term or any Renewal Term of the Agreement for 2 consecutive months. In addition, Merchant will pay FSP any Annual fees owed for the remainder of the then current term. Merchant Initials: Version 2 10/11 FrontStream Payments is a registered ISO/MSP of First National Bank of Omaha, Omaha, NE Page 3 of 4 FNBO 1620 Dodge St Omaha, NE
5 Previously Processing with AMEX? AMEX Yes No Existing AMEX account ID #: Do you want to apply for AMEX? Yes No Check One: Retail- $0.10 Trans Fee % Card Not Present Fee Services, Wholesale & All Other- $0.15 Trans Fee Check One: Discount Rate: Monthly Flat Fee $7.95* % New Merchant Only X / / Signature of Guarantor 1 Estimated Annual Volume: Pay Frequency: 3 Day 15 Day 30 Day Estimated Average Ticket: *Merchants With Less Than $5, Annual American Express Volume Will Be Subject To A Monthly Flat Fee Of $7.95 And Will Revert To EDC Discount When Annual Exceeds $5,000. By signing above, I represent that I have read and am authorized to sign and submit this application for the above entity which agrees to be bound by the American Express Card Acceptance Agreement ( Agreement ), and that all information provided herein is true, complete and accurate. I authorize FrontStream Payments ( FSP ) and American Express Travel Related Services Company, Inc. ( AMERICAN EXPRESS ) and AMERICAN EXPRESS s agents and Affiliates to verify the information in this application and receive and exchange information about me personally, including by requesting reports from consumer reporting agencies, and disclose such information to their agent, subcontractors, Affiliates and other parties for any purpose permitted by law. I authorize and direct FSP and AMERICAN EXPRESS and AMERICAN EXPRESS s agents and Affiliates to inform me directly, or through the entity above, of reports about me that they have requested from consumer reporting agencies. Such information will include the name and address of the agency furnishing the report. I also authorize AMERICAN EXPRESS to use the reports from consumer reporting agencies for marketing and administrative purposes. I understand that upon AMERICAN EXPRESS s approval of the Application, the entity will be provided with the Agreement and materials welcoming it to AMERICAN EXPRESS s Card acceptance program. In addition, by signing this form, you authorize American Express and its agents and Affiliates to send you account information and exclusive offers and savings for your business via the information that you have provided, which includes your business address. For information on how we use your information and protect your privacy, please visit us at Merchant Guaranty & Acceptance GUARANTY: THIS general, absolute, and unconditional continuing Guaranty ("GUARANTY") by the undersigned (collectively "GUARANTOR" or "my" or "I" or "me"), is for the benefit of First National Merchant Solutions, LLC, First National Bank of Omaha and FrontStream Payments (collectively referred to as "FNBO"). For value received, and in consideration of the mutual undertakings contained in the merchant transaction processing agreement and allied agreements ("AGREEMENT") between FNBO and ("MERCHANT" as set forth below), I absolutely and unconditionally guarantee the full performance of all MERCHANT s obligations to FNBO, together with all costs, expenses, and attorneys' fees incurred by FNBO in connection with any actions, inactions, or defaults of MERCHANT. I waive any right to require FNBO to proceed against other entities or MERCHANT. There are no conditions attached to the enforcement of this GUARANTY. I authorize FNBO, its agents or assignees to make from time to time any personal credit or other inquiries and agree to provide, at FNBO's request, financial statements and/or tax returns. I agree that this GUARANTY shall be governed and construed in accordance with the laws of the state of Nebraska, and that the courts of the state of Nebraska shall have and be vested with personal jurisdiction over me. This is a continuing GUARANTY and shall remain in effect until one hundred eighty (180) days after receipt by FNBO of written notice by me terminating or modifying the same. The termination of AGREEMENT or GUARANTY shall not release me from liability with respect to any obligations incurred before the effective date of termination. No termination of this GUARANTY shall be effected by any change in my legal status or any change in the relationship between MERCHANT and me. This GUARANTY shall bind and inure to the benefit of the personal representatives, heirs, administrators, successors and assignees of GUARANTOR and FNBO. X / / Signature of Guarantor 1 (#1 From Application) Printed Name of Guarantor 1: Printed Name of Guarantor 2: X / / Signature of Guarantor 2 (#2 From Application) Percent of Ownership Title: Percent of Ownership Title: SSN# DOB (mm/dd/yyyy): / / SSN# DOB (mm/dd/yyyy): / / Acceptance: "By their execution below the undersigned parties agree to abide by the Merchant Transaction Processing Agreement (the AGREEMENT ). The AGREEMENT consists of the Merchant Application and the Terms and Conditions (a separate attachment hereto), and MERCHANT acknowledges receipt of the terms and conditions at the time of signing. MERCHANT warrants that the information provided on the Merchant Application is complete and accurate. MERCHANT authorizes FNMS and/or BANK to provide a copy of this Merchant Application to any third party for the services requested. MERCHANT, and its signing officer/owner/partner, authorize FNMS and/or BANK, or its agents or assignees, to make from time to time, any business and personal credit and other inquiries. Depending upon Merchant's authorization and settlement composition, the references to Discover Network in this Agreement may not apply and Merchant may contract directly with Discover Network for these services. If applicable, MERCHANT agrees by its signature below to the Equipment Agreement. In witness whereof the parties hereto have caused this AGREEMENT to be executed by their duly authorized representatives effective on the date signed or approved by BANK." X / / Signature of Authorized Signer X / / FNMS Signature X / / Bank Signature X / / FSP Signature Principal s Name: (Please Print) Name: (Please Print) Name: (Please Print) Name: (Please Print) MERCHANT has indicated above which services it is requesting. MERCHANT agrees that BANK and FNMS are not parties to any agreement for services from the following companies: American Express and Discover Network*, and that any such agreements are strictly between MERCHANT and each individual company. MERCHANT must be approved by each company and each company may send its agreement to the address of MERCHANT indicated herein upon such approval. MERCHANT agrees to be bound by such company s agreement. [*NOTE: Depending upon MERCHANT S authorization and settlement composition, MERCHANT may not have a direct agreement with Discover Network and instead will receive Discover Network services through this agreement with FNMS. If that is the circumstance, the portion of this disclosure pertaining to Discover Network vices does not apply.] Internal Use Only Front End Network: Merchant #: MCC: Referral Source/Association Name: Sales Rep: Channel: Chain#: Monthly Gross Pay Daily Gross Pay Title: Title: Title: Title: Version FrontStream Payments is a registered ISO/MSP of First National Bank of Omaha, Omaha, NE Page 4 of 4 FNBO 1620 Dodge St Omaha, NE
6 11 MERCHANT INFORMATION ENROLLMENT FORM Automated Clearing House (ACH) Merchant DBA Name Merchant Legal Name Merchant Address City State Zip Code Merchant Contact Name Merchant Contact Phone Merchant Address 2 ACH INFORMATION ACH Services Information Total Debit Transaction Volume per file: ACH original Debits/Credits $ per Debit/Credit Total Dollar Volume per file: ACH Fatal Returns $ per Fatal Return No. of files submitted (choose one) ACH Re-clears $ per Re-Clear # of files Daily # of files Weekly # of files Monthly Re-clear Return Items (choose one) Yes [ ] No [ ] ACH Entry Types Requested: ARC [ ] % of Total CCD [ ] % of Total ACH Exception notifications should be forwarded to the following address: PPD [ ] % of Total WEB [ ] % of Total POP [ ] % of Total TEL [ ] % of Total RCK [ ] % of Total Third Party Sender (TPS) is: Merchant agrees to pay the fees listed herein. Further, if Merchant is utilizing ACH Services hereunder, Merchant agrees to be bound by the Automated Clearing House ( ACH ) Services Amendment To the Merchant Transaction Processing Agreement and Merchant acknowledges receipt of the same. Initials Rev First National Merchant Solutions, LLC
7 PRODUCTS AND SERVICES AMENDMENT TO THE MERCHANT TRANSACTION PROCESSING AGREEMENT THIS Amendment ("AMENDMENT"), by and between FIRST NATIONAL BANK OF OMAHA ("BANK"), First National Merchant Solutions, LLC ( FNMS ), and MERCHANT, the name of which is set out below, shall become effective on the date executed by a duly authorized representative of BANK. BANK, FNMS, and MERCHANT shall be collectively known hereafter as the "PARTIES." WHEREAS, BANK, FNMS, and MERCHANT are PARTIES to a Merchant Transaction Processing Agreement (together with its addenda, attachments, and schedules shall be hereinafter known as the "AGREEMENT"), under which BANK and FNMS provide transaction processing and other services regarding credit and debit card sales transactions ( SALES ), subject to the terms and conditions more fully set out in AGREEMENT; and WHEREAS, BANK has entered into an agreement to contribute its merchant acquiring business, through a series of structuring transactions, to a newly-formed Delaware limited liability company called First National Merchant Solutions, LLC ( FNMS ) (the Transaction ). In connection with the Transaction, SPC Inc., a whollyowned subsidiary of BANK ( SPC ), has been merged with and into FNMS. As a result of the Transaction, certain of BANK s rights and obligations that were previously being performed on BANK s behalf by SPC have been transferred to FNMS; and WHEREAS, the PARTIES desire to amend the AGREEMENT as set out below. NOW THEREFORE, in consideration of the mutual promises made herein and other valuable consideration, receipt and sufficiency of which are hereby acknowledged, the PARTIES do hereby agree as follows: 1. GENERAL: 1.1 Capitalized terms that are not defined herein shall have the same meaning as when defined in the AGREEMENT. 1.2 To the extent FNMS is not already a PARTY to the AGREEMENT, the PARTIES agree to amend the AGREEMENT to make FNMS a party to the AGREEMENT. BANK will continue to sponsor MERCHANT into the ASSOCIATIONS, retain the responsibility of settling MERCHANT s SALES, and all other obligations that are required to be retained at BANK by the ASSOCIATIONS. FNMS will be responsible for all other responsibilities and obligations to MERCHANT under the AGREEMENT, including but not limited to processing SALES and handling customer service. 2. PRODUCTS AND SERVICES TERMS AND CONDITIONS: 2.1 MERCHANT agrees to pay the fees as set out herein and as may be amended from time to time. MERCHANT agrees to abide by all parameters set out in any specifications or documentation as amended from time to time. MERCHANT agrees to provide the information requested in the Enrollment form(s), attached hereto as Exhibit A and incorporated herein by this reference. 2.2 The PARTIES agree to add the following products and/or services to SERVICES. PayFuse First Billing First Batch First Account Updater ACH Services* *If ACH Services are checked, by its signature below MERCHANT acknowledges receipt of and agrees to be bound by the Automated Clearing House ( ACH ) Services Amendment To the Merchant Transaction Processing Agreement. 3. MISCELLANEOUS: 3.1 This AMENDMENT, together with the AGREEMENT and its other amendments, attachments, exhibits, and schedules, constitutes the entire AGREEMENT between the PARTIES as to transaction processing, and any other representations, inducements, promises, or agreements not contained herein shall be of no force and effect as to transaction processing Page 1 of 2 CONFIDENTIAL
8 3.2 Except as amended hereby, BANK, FNMS, and MERCHANT reaffirm the obligations of each as they are contained in the AGREEMENT. IN WITNESS WHEREOF, the PARTIES hereto have caused this AMENDMENT to be executed by their duly authorized representative, effective as of the date executed by BANK. First National Bank of Omaha MERCHANT Name Authorized Signature Print Name Address City, State, Zip Code Title Authorized Signature Date Print Name Ti First National Merchant Solutions, LLC tle Authorized Signature Print Name Title Date 0610 Page 2 of 2 CONFIDENTIAL
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