ppx Merchant Application

PAYMENT PROCESSING EXCHANGE

Payment Processing Application

We are now ready to gather the necessary information about your business and payment processing needs to allow 3rd party payment processors to bid on your business.

In order to complete this section, you will need:

Your Employer Identification Number (EIN) or, if you operate a sole proprietorship, your Social Security Number (SSN)
A recent statement from your current payment processor, if you have one
Your business bank account information (bank name, routing number, and account number)

Your identity will not be disclosed to the processors until you have selected the business partner who is best meeting your needs and is offering you the best value. At that point, we will put you in touch with the winning processor to have the payment services enabled at your establishments.

If you gave us access to your existing payment processor account, we will prepopulate as much of the form as possible for you. Please review the information in the form carefully and make sure that it is complete and accurate.

When payment processors compete for your business, you win!

Business Contact Information:

Owner/Primary Contact:

Name:

Position:

Address:

Date of Birth:

Social Security Number:

Email:

Phone:

Secondary Contact:

Name:

Position:

Address:

Date of Birth:

Social Security Number:

Email:

Phone:

Nature of Business & Payment Information:

Industry:

Expected MONTHLY payment volume:

Breakdown by Payment Type:

% V/MC Credit

% V/MC Debit

% Amex

Breakdown by Transaction Type:

% Card Present/Swiped

% Card Present/Keyed

% Mail/Telephone Order

% Internet (e-Commerce)

Breakdown by Customer Type:

% Sales to Consumer

% Sales to Corporations

% Sales to Government

Average Transaction Size:

Largest Transaction Size:

On average, what percentage of your sales are returned by your customers?

Do you sometimes bill customers in advance of delivering the product/service?

Yes No

What percent of your sales is subject to advance billing?

On average, how many days in advance do you bill on such sales?

Preferred Pricing & Payment Options:

In this section you have the opportunity to select your preferred way of paying for transaction processing services. Note that not all processors may be able to accommodate your preferences.

Transaction Pricing: Payment processors charge for their services primarily in two ways:

Multi-Tier Pricing: each transaction is classified into one of several (typically three) price tiers, based on the type of card that was used in the transaction and whether the card was physically present.
Interchange-Plus Pricing: the exact amount of the "interchange" (fees charged by the card issuing banks and the payment networks) is passed through to the merchant and a fixed markup is added for each transaction.

Less common pricing structures are One Rate Pricing, where the same rate/fee is applied to all transactions, and Flat Monthly Fee, where a lump sum monthly fee is charged regardless of the number of transactions processed.

Speed of Pay: Some processors will deposit proceeds from your customer sales into you bank the next day, some may deposit your funds several days later. Let the processors know your preference below.

Payment Plan: You can elect to pay the payment processor daily or at the end of the month. Paying at the end of the month can make bookkeeping and reconciliation easier.

Transaction Processing Equipment:

In this section, tell your processor what type of payment processing equipment you already have,whether you want to keep it, and what types of additional equipment you might need.

Value-Added Processor Services:

Some processors offer a variety of optional value-added services (Note that these services will typically be offered for an additional fee).

If you are interested in any of these services, please let the processors know by checking the corresponding boxes below. Each processor's quote will indicate whether they can provide the desired services and at what price.

Bank Account Information:

In this section, please specify the bank account information that you wish to have the processor deposit your daily sales into. Note that you will need a business bank account for this purpose. If you like, you can specify a separate bank account for withholding of processing fees to aid with bookkeeping and reconciliation.

Note that we will not disclose your bank account details to any of the processors until you have selected the processor you wish to engage. At that point we will make your banking information available to the processor in order to complete the contract and allow the processor to begin depositing your daily net sales proceeds to this account.

Primary Bank Account (for deposit of sales amounts):

Bank Name:

Bank Routing Number:

Account Number:

Name on the Account:

Do you wish to use the same bank account for payment processor fees?