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Merchant profile questionnaire

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Merchant Questionnaire - To be filled out and submitted at time of pro forma or application.

Merchant Questionnaire - To be filled out and submitted at time of pro forma or application.

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  • 1. Merchant Profile Questionnaire To be completed by Sales Agent and provided with merchant statements 1. Merchant Name____________________________________________________ 2. Sales Agent Name__________________________________________________ 3. Number of Locations__________________________ 4. Current total number of terminals per location________________ 5. Terminal Type (select one) ○ Internet (Virtual Terminal) ○ Dial (phone cable) ○ Wireless (no cable) ○ Datawire/IP (ethernet cable) ○ Other________________ 6. If processing credit cards on internet, what gateway and supporting software do they use? (ex. authorize.net, quickbooks, eProcessing, etc.)__________________________ ______________________________________________________________________ 7. If processing credit cards on Internet, is merchant billed directly by gateway or processing software company?_____________________________________________ 8. Terminal(s) brand and model number (ex. Verifone Vx510, MICROS e7, FD100, etc.)__________________________________________________________________ 9. Terminal(s) owned or leased?______________________ 10. Does current processor have early termination fee?__________ if so, $__________
  • 2. 11. Do they want their terminal to auto close, or batch manually? __________ If yes, what time? ____________________ 12. Do they want to accept PIN debit? _____________ If yes, do they have a compatible PIN pad or do they need one?____________________ PIN Pad make and model_________________________________________________________________ 13. Do you have a check reader, or require a check reader?_____________ If yes, what is the make/model of your check reader?________________________________ 14. Are there any other needs regarding 3rd party software or integrated applications? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 15. Is there anything else NEXTEP Processing will need to know before setting up their accounts? ______________________________________________________________________ ______________________________________________________________________ _____________________________________________________________ 16. Contact person for the download:________________________________________ Best contact number: ____________________________________________________ Contact email: _________________________________________________________ Application Checklist: ____ Signed and Completed Merchant Applications ____ Voided bank check from account where debits/deposits will be made ____ Signed confirmation page ____ Merchant Profile Questionnaire