2015 Submission Requirements / Merchant Application Support Department: Support@PDLmerchantsolutions.com Emai:Support@pdlmerchantsol utions.com
2015 CARD SUBMISSION REQUIREMENTS: Executed PDL Merchant Application (Typed Only) 6 Months Current Processing Statements 6 Months Recent Bank Statements Corporate Documents (Articles, SS4, Charter, Licenses, etc.) Corporate Tax Returns (Past 2 years) Voided Check or Bank Letter (On Bank Letterhead: Showing full routing and account #) Corporate Financials* (If processing over 250K Per month: P&L and Balance Sheet) Fulfillment Agreement (If Applicable) DL or Passport(s) For all Account Signatories /Owners List of all URLs Personal Utility Bill (Within 6 Months)-Must Be in the Owner's Name-Not the Corporation CV(s) For All Account Signatories/Owners 2015 ACH SUBMISSION REQUIREMENTS: (In addition to the above, please provide / complete the following for ACH Services.) States that you lend in and State Licenses 6 Months Recent ACH Statements Sample Loan Agreement with NACHA Language List of All Third Party Member Organizations Affiliated With (NAFSA, OLA, etc.) Copy of Payment Schedule Relative to Amounts Loaned If you are a Tribal Lender, please provide any and all applicable information on the following: Sovereign Immunity, Governing Law, and Tribal Dispute & Resolution Procedures Voided Check or Bank Letter (On Bank Letterhead: Showing full routing and account #)-If different than the DDA Account to be used for card processing deposits NOTE: Based upon business type, additional requirements may be necessary. Please contact a PDL Representative if you should have any questions.
Business Information: Merchant s DBA: Physical Address (No P.O. Box): City, State, Zip: Merchant Application (Card Acceptance) Merchant s Legal Name: Legal Address: City, State, Zip: Customer Service Phone: DBA Fax: Legal Phone: Legal Fax: Contact Person: Contact Phone: Contact Email: URLs: Customer Service Hours: Customer Service Email: Federal Tax ID/ Registration#: Date of Incorporation: Merchant Profile: Processing Information: Has the business or any associated owner ever been terminated as a Ownership Type: LLC Corporation Sole Prop Partnership Tax Exempt Other: VISA /MasterCard /Discover Merchant? YES NO Describe Products or Services in Detail: Is the above listed entity organized under tribal law and is thus wholly-owned and controlled by an American Indian Tribe? Yes No If YES, please list the federally-recognized Tribe: Card Transaction Profile: Do you currently accept VISA /MasterCard /Discover? If YES, please submit 6 current monthly statements for each merchant account currently open. Who are you currently processing with (Please list ALL applicable ISOs and acquirers)? How many depository bank accounts are related to these merchant accounts? What is your minimum and maximum loan term and loan amount? YES NO Sales Profile (Must equal 100%): Card Swiped: MOTO: Internet: TOTAL: Retail Mail / Phone Internet States of licensure: Have any of the listed owners or related entities listed herein ever been party to a lawsuit, sanction, or consumer protection inquiry by any state, federal, or regulatory agency in regards to loan and or marketing practices? Yes No If YES, Please provide complete details: Monthly VISA / MC / Discover Sales: Average Ticket: High Ticket: Describe high ticket in detail: Card Types Accepted: Visa MasterCard Discover Merchant Site Inspection Report: The Merchant: Owns Leases Landlord s Name: Merchant Location: Office Building Residence Retail Storefront Area is Zoned: Commercial Residential Industrial Square Footage: 0-250 251-500 501-2000 2001+ AMEX (Current SE #) Landlord Phone: Mobile Merchant Shopping Center Does the inventory, merchandise, and staff appear to be consistent with the type of business? YES NO If no, please explain:
Owner and Officer Information: Owner 1 Name: Title: % Ownership Social Security Number: Home Address: City: State: Zip: Own or Rent: Time at Residence (Years): Date of Birth: Drivers License or Passport #: DL State: DL or Passport Expiration: Home Phone: Cell Phone: Email Address: Skype ID: Have you ever filed for Personal or Business bankruptcy?( If yes, please provide details below and submit the related discharge letter along with the application): Owner 2 Name: Title: % Ownership Social Security Number: Home Address: City: State: Zip: Own or Rent: Time at Residence (Years): Date of Birth: Drivers License or Passport #: DL State: DL or Passport Expiration: Home Phone: Cell Phone: Email Address: Skype ID: Have you ever filed for Personal or Business bankruptcy?( If yes, please provide details below and submit the related discharge letter along with the application): Banking Information (Please Include a Voided Check or Bank Letter): Deposits / Withdrawals: Bank Name: Bank Account # / DDA: Routing # / ABA (9 digits): Bank Phone Number: Deposits & Withdrawals Deposits Only Checking Account Withdrawals Only Checking Account Cardholder Data Storage Compliance (Security): Do you store card numbers? Yes No Are you currently PCI DSS Compliant? Yes No Do you or your Service Provider(s) receive, pass, or transmit or store the full Cardholder Number FCN, electronically? Yes No Have you been subject to any ongoing or previous compromise investigations? Yes No If yes, please explain: If yes, where is card data stored? Primary Service Provider Other: Merchant location Only Both Merchant & Service Provider _ Do you use a Fulfillment House? Yes No Phone: Fulfillment Contact Information (Name, Contact Person, Address):
Processing, Billing, and Marketing Profile: How many total chargebacks (across all MIDS) have you had in the past 6 months?: What was the total dollar amount of those chargebacks? What chargeback management tools do you currently utilize? Have you ever been notified that you have been placed on the chargeback monitoring program? If so, when, why, and for how long? What is your average monthly transaction count (across all MIDS)? Have you ever had a merchant account closed or terminated for excessive chargebacks? Yes No If yes, please provide details {Date(s), Name of Processor(s), Name of Aquirer(s)}: What is your reason for applying for a merchant account? Need Additional Volume Terminated Other Details: How often is the customer charged? Weekly Monthly Other If Other, Details: After a loan is approved, how long does it take for a client to receive their funds? Of the loans offered, what is the percentage of collaterilized loans versus unsecured loans? What is your current Better Business Bureau Rating? Collateralized Unsecured Requested Billing Descriptor: Company Billing Contact Person (Refunds, Disputes, Chargebacks, etc.): Name: Phone: How do you advertise your products or services? (Catalogs, Magazines, TV, Internet, etc. List all that apply): Please describe your refund policy (if applicable): Is a Call Center used? Yes No Call Center Name: Contact Person: Phone Number: Call Center Address: lease describe your internal chargeback response process and related procedures:
General Business Information: GENERAL BUSINESS INFORMATION Company Name: DBA Name: Legal Address: DBA Address: Primary Contact: Phone: City, State, Zip: City, State, Zip: Fax: Email: Technical Contact: Phone: Fax: Email: Billing Contact: Phone: Fax: Email: Date Established: Number of Locations: Number of Employees: Federal Tax ID: D&B Number: SIC: Business Structure: Corporation Sole Proprietorship General Partnership LLC Publicly Held Other Web Address: Customer Service Number: Days & Hours of Operation: Business Time Zone: Business Site: Office Suite Retail Storefront Private Residence Other Annual Sales Volume: % Check Sales % Credit Card Sales Bank Reference Information: BANK REFERENCE INFORMATION Merchant Application (ACH) Primary Bank: Branch Address: Bank Officer: Phone: Name on Account: Date Opened: Merchant Settlement DDA: Routing #: Account #: Business BUSINESS Credit CREDIT References: REFERENCES (1) Company Name Years of Business Relationship: Contact Name: Business Telephone: Business Fax: Address: City: State: Zip: (2) Company Name Years of Business Relationship: Contact Name: Business Telephone: Business Fax: Address: City: State: Zip: Ownership OWNERSHIP and & PERSONAL Personal INFORMATION Information: Note: Named individuals must be majority owners. N/A for Publicly Held Companies or non-profit organizations. (1) Name: Title: % Ownership: Residence: City: State: Zip: Date of Birth: Drivers License Number & State of Issue: Social Security #: Bankruptcy or Lawsuits: Yes No (If Yes, please include explanation letter.) (2) Name: Title: % Ownership: Residence: City: State: Zip: Date of Birth: Drivers License Number & State of Issue: Social Security #: Bankruptcy or Lawsuits: Yes No (If Yes, please include explanation letter.)
Product and Sales Information: Brief Business Description: Goods/Services to be Purchased with Electronic Checks: Payments or Purchases Are From: Businesses Consumers What % from Businesses: % Consumers % How are you obtaining authorization? Telephone Written Internet Other How Do You Advertise These Goods/Services? Catalog Direct Mail TV/Radio Telemarketing Newspaper/Magazine Merchant Refund Policy: No Refund Refund in 30 Days or Less Other Have You Accepted ACH Payments Before? Yes No Name of Previous ACH Processor: Projected Transaction Activity: PROJECTED TRANSACTION ACTIVITY Type of ACH Payments: Direct Debit (PPD) Telephone Checks (TEL) Internet Checks (WEB) Paper Check Conversion (ARC) For TEL transactions, do you: Record calls Yes No -or- Send a notice prior to debiting account Yes No If you record calls, please send with this application a copy of the script in use (or to be used) by representatives on the call. If you do not record calls, but send notices prior to debiting the account, please send a copy of the customer notification with this application. For WEB transactions, you will be required to perform an annual WEB security audit. You will be provided with WEB compliance specifications. Frequency, Volume and Description of ACH Transactions: (Please complete separate line for each type of payment.) Transaction Type Debits Credits Frequency of Files (Weekly, Daily, Monthly, Other) Payments Are For (Payroll, Dues, Retail, etc.) Number of Payments Average Payment Amount % Expected Returns (NSF, Account Closed, etc.) % Expected Unauthorized Returns Accounts Have Transaction, Daily & Monthly Maximum Processing Limits. Please Identify Your Processing Needs: Maximum Transaction Dollar Limit Maximum Daily Dollar Limit Maximum Monthly Dollar Limit Debits Credits Case Notes or Special Requests:
Declarations / Investigate Consumer Report: Declarations: I hereby confirm to be the owner of the listed website(s). I further declare to have full control and authorization of the website content. I acknowledge and agree that I will not use the Processing System for transactions relating to; 1) Sales made under a different trade name or business affiliation than indicated on this Agreement or otherwise approved by the acquirer in writing; 2) Fines or Penalties of any kind, losses, damages or any other costs that are beyond the Total Sale Price; 3) Any transaction that violates any law, ordinance, or regulation applicable to my business; 4) Goods which I / we know will be resold by a customer whom I / we reasonably should know is not ordinarily in the business of selling such goods; 5) Sales by third parties; 6) Any other amounts for which a customer has not specifically authorized payment through the acquirer; 7) Cash, traveler's checks, Cash equivalents, or other negotiable instruments; or 8) Amounts which do not represent a bona fide sale of goods or services by me /us. I also declare on behalf of the company and on behalf of myself that, to the best of our knowledge, neither the company nor the website nor myself (or any of us) have ever been involved in excessive chargeback s, fraud or content violation nor have any of the above ever terminated by an acquirer or asked by an acquirer to terminate an agreement within a set period of time. Further, I also understand that PDL Merchant Solutions can refuse to assist with and or provide Card or ACH processing services for my website, company, or any related or affiliated businesses I own in part or in whole at its sole discretion. Investigate Consumer Report An investigative or consumer report may be made in connection with application. Merchant authorizes any party to the agreement or any of their agents to investigate the reference provided or any other statements or data obtained from merchant and from any of the undersigned personal guarantor(s), or from any person or entity with any financial obligations under this agreement. You have a right, upon written request, to a complete and accurate disclosure of the nature of and scope of the investigation requested. By Signing or Printing your name below, you hereby agree and accept: Owner #1: Date: Owner #2: Date: Included in the submission of: 6 Months Processing Statements 6 Months Bank Statements Corporate Documents (Articles, SS4, Licenses, etc) DL or Passport(s) for all account Signatories / Owners Tax Returns (Past 2 years) Voided Check or Bank Letter Corporate Financials (P&L, Balance Sheet) Fulfillment Agreement List of all URLs 6 Months ACH Statements Copy of State Licenses Sample Loan Agreement with NACHA Language Copy of Payment Schedule List of Third Party Member Organizations Sovereign Immunity, Governing Law, and Tribal Information (if Applicable) 2 nd Voided Check or Bank Letter (if different than the DDA Account to be used for Card Processing Deposits)