Business Name *

Agent/Sales Code *

1. Submit completed application with the following supporting documents:

Signed app

Voided Check (or bank letter)

Previous processing statement(s)

Owner's Driver's License

Bank statements if high volume merchant

Signed Gateway Only Agreement if setting up Cardpointe Gateway

2. Provide the following information when submitting a new Merchant Application:

a. Customer Type - Consumers vs. Business:

Consumers (%)

Business (%)

Wholesaler/B2B?

b. How Processing?

Credit Card Terminal

Virtual Terminal

POS

Mobile

Online

c. Card-Present swiped vs. keyed-in transactions?

Card-Present swiped

keyed-in transactions?

d. High Ticket $ and How often? $

High Ticket

How often?

Refund/Exchange Policy

f. Service/Product Delivery? (%)

1-7 days

7-14 days

15-30 days

30+ days

g. Mobile Devices needed?

Mobile Devices Qty

h. Hosted Payment Page?

i. Clique demo to be scheduled?

3. Update or Add Merchant record in Zendesk Sell as a Customer and fill all required fields (indicated with *). Account set-up and equipment installation will not be done without this step.

4. Additional Information:

a. Type of Equipment to be ordered:

Equipment 1

Qty:

Equipment 2

Qty:

b. Amount billing merchant for equipment:

c. Accepting Pin-debit?

d. Accepting EBT?

Note: if yes, merchant FCS permit #

e. Option for Tips?

f. Cash back option?

g. Cash discounting?

If Yes, what percentage?

h. Processing method:

i. Batch Reporting:

j. Batch Close preference:

Manual

Auto - batch close time