MPA Merchant Agreement

MPA

Create New Application
Agent Email
Agent Name

First NameLast Name
Portfolio
Processor
Agent Director
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
Is the mailing address the same as the business address?
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
Merchant Profile
Daily Or Monthly Discount
Statement fee
App Fee
PCI Enhancement Security Package
Monthly Minimum
Connectivity
For LTE, please choose Wireless
Backend
Equipment
Clover Service Plan ( If applicable )
Valor Service Plan ( If applicable )
If you wish to upcharge the merchant please include info under notes section at the end
Equipment Type
Do you need the office to install?
Virtual Terminal/Gateway
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 )
Include fees upcharge info/amounts, LTE, agent covering costs, etc.
Monthly Volume
Monthly Volume - Other
Monthly Amex Volume
Average Ticket
XAverage Ticket
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, type of business, Etc
Please explain what is the business model Ex: grocery store, Auto shop, tire shop etc
Shipping
Voided Check

Upload if necessary
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Bank Statements or Merchants Statements If needed

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Additional Documents Needed

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Should be Empty: