MPA Merchant Agreement

MPA

Create New Application
Agent Email*
Agent Name*

First NameLast Name
Portfolio*
Processor
Jacqueline HardyShamilette RodriguezJamaar Manlove
Merchant Legal Name
Merchants Legal Business name
Merchant DBA NAME
Doing Business As Name
Merchant Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
MERCHANT EIN- TAX ID
Merchant Entity*
Merchant Type*
Merchant Type of Business
Auto Sales, Pet Supply, Animal Hospital,
Merchant Business Start Date

MonthDayYear
Date
Merchant Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Merchant Email
Owner 1 Name

First NameLast Name
Merchant Home Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ownership Percentage 1
Owner 1 Email
example@example.com
Owner 1 Cell Number
OptionalFormat: (000) 000-0000.
Date of Birth 1

MonthDayYear
Date
SSN 1
Optional
Owner 2 Name

First NameLast Name
Merchant Home Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ownership Percentage 2
Owner 2 Email
example@example.com
Date of Birth 2

MonthDayYear
Date
SSN 2
Optional
Percent of Business
Program Type *
Rate*
Example Interchange .20 bbs and .10- Reads 20bbs and 10 Cents
RetailRetail TipRestaurantGovernmentB2B Level IIILodgingSupermarketInternetMOTO-MAIL ORDER TELEPHONE ORDER
DailyMonthly
Statement fee*
App Fee*
PCI Enhancement Security Package*
Monthly Minimum*
Connectivity
Backend
Equipment
Clover Service Plan ( If applicable )
Equipment Type*
Do you need the office to install?
Not applicableFluid PayAuth.netNMISoftwareNMI + Biller Genie - Quickbooks
Integration Specs (If Applicable)
Please explain how the merchant will be using the integration (e.g., website, crm, etc.)
AUTO BATCH YES OR NO
Batch Time

Hour Minutes

AM/PM Option
xClover Service Plan ( If applicable )
Valor Specs ( please be specific: tips, signature etc )
5000.0010000.0020000.0030000.0050000.0075000.00100000.00200000.00250000.00500000.001000000.00Other
Monthly Volume - Other
Monthly Amex Volume
5.0010.0050.00100.00500.001000.002500.004000.00Other Place In Notes
5.0010.0020.0050.00100.00500.001000.002500.004000.00Other Place In Notes
High Ticket*
Remember anything over 9900 needs 3 months merchant statement and bank statement
Bank Name
ABA ROUTING NUMBER
Remember starts with 0, 1, 2 or 3 Only ( 9 Numbers)
ACCOUNT NUMBER
You can leave blank
Agent Note Section - Ship to Info Etc
Ship OvernightShip GroundOffice Installs from Orlando OfficeDoes not Apply
Voided Check

Upload if necessary
Cancelof
Bank Statements or Merchants Statements If needed

Cancelof
Additional Documents Needed

Cancelof
Should be Empty: