This document is a merchant profile questionnaire completed by a sales agent to gather information about a merchant's payment processing needs. It collects details about the merchant's locations, terminals, gateway/software, auto close times, PIN debit acceptance, check readers, and contact information. The questionnaire ensures the new processor has essential details to properly set up the merchant's accounts for payment processing.

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