Harbortouch POS Account Submission Checklist - United Bank Card

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H A R B O R T O U C HM E R C H A N T A P P L I C AT I O NVISA DISCLOSUREMEMBER BANK (ACQUIRER) INFORMATIONMERCHANT INFORMATIONACQUIRER NAME:ACQUIRER ADDRESS:ACQUIRER PHONE:First National <strong>Bank</strong> of Omaha1620 Dodge Street, Omaha, NE 68197(800) 853-9586MERCHANT DBA NAME:MERCHANT ADDRESS:MERCHANT PHONE:IMPORTANT MEMBER BANK (ACQUIRER) RESPONSIBILITIES1. A Visa Member is the only entity approved to extend acceptance of Visa products directly to a Merchant.2. A Visa Member must be a principal (signer) to the Merchant Agreement.3. The Visa Member is responsible for educating Merchants or pertinent Visa Operating Regulations with whichMerchants must comply.4. The Visa Member is responsible for and must provide settlement funds to the Merchant.5. The Visa Member is responsible for all funds held in reserve that are derived from settlement.IMPORTANT MERCHANT RESPONSIBILITIES1. Ensure compliance with cardholder data security and storage requirements.2. Maintain fraud and chargebacks below thresholds.3. Review and understand the terms of the Merchant Agreement.4. Comply with Visa Operating Regulations.The responsibilities listed above do not supercede terms of the Merchant Agreement and are provided to ensure the Merchant understands some important obligations of each party andthat the Visa Member (Acquirer) is the ultimate authority should the Merchant have any problems.xMERCHANT'S SIGNATUREDATEMERCHANT'S NAME AND TITLEHARBORTOUCH2202 North Irving StreetAllentown, PA 18109JUNE12HARBORTOUCH IS A REGISTERED ISO/MSP OF FIRST NATIONAL BANK OF OMAHA, 1620 DODGE ST., OMAHA, NE – FDICTel: 866-563-3045Fax: 908-730-7437www.harbortouch.comPAGE 1 OF 4HT1145_06072012
PROMO CODE:H A R B O R T O U C HAGENT NAMEOFFICE PHONE OFFICE CODEREP CODEASSOCOFFICE USEONLYNEW LOCATION OWNERSHIP CHANGE ADDITIONAL LOCATIONMERCHANT #SIC CODE FAIR ISAAC SCORE ANALYSTSECTION A — PLEASE COMPLETE MERCHANT'S BUSINESS INFORMATIONA1 MERCHANT INFORMATIONNAME OF ACCOUNT (DOING BUSINESS AS)EXACT LEGAL NAMEDBA ADDRESS (IF DIFFERENT FROM LEGAL)CITY COUNTYSTATE ZIPLEGAL ADDRESSCITY COUNTYSTATE ZIPCONTACTTELEPHONE #FAX #FEDERAL TAX I.D. NUMBERMERCHANT E-MAIL ADDRESS (AGENT E-MAIL ADDRESS CANNOT BE ACCEPTED)WEBSITE ADDRESSGO GREEN - OPT IN FOR PAPERLESS STATEMENTS (MUST PROVIDE E-MAIL ADDRESS)TYPE OF OWNERSHIP: SOLE PROPRIETOR PARTNERSHIP CORPORATION LLC NON-PROFIT OTHER:A2MERCHANT PROFILEMERCHANDISE/SERVICE SOLDYEARS IN BUSINESSPERCENT OF BUSINESSLENGTH OF CURRENT OWNERSHIP # OF LOCATIONS MONTHLY VOLUME AVERAGE TICKET AMOUNT HIGHEST TICKET AMOUNT$ $ $HAS MERCHANT OR ANY PRINCIPAL BEEN TERMINATED AS A VISA/MASTERCARD MERCHANT (TMF)?YES NO REASON:HAS MERCHANT OR ANY PRINCIPAL DISCLOSED BELOW FILED BANKRUPTCY OR BEEN SUBJECT TO ANY INVOLUNTARY BANKRUPTCY?YES NO REASON:HAS MERCHANT PREVIOUSLY ACCEPTED CREDIT CARDS? YES NOPROCESSOR:DOES MERCHANT CONDUCT BUSINESS SEASONALLY?PLEASE CONTACT CUSTOMER SERVICE TO DEACTIVATE ACCOUNT DURING SEASONAL MONTHSDOES THE BUSINESS USE ANY THIRD PARTIES IN THE PAYMENT PROCESS?YES NOIF YES, PLEASE LIST:REFUND POLICY:YESNOIF YES, PLEASE PROVIDE COPIES OF MOST RECENT STATEMENTCARD SWIPEDMANUAL KEY WITH IMPRINTMAIL ORDER/TELEPHONE ORDEREach merchant certifies that the average ticket size, highest ticket and sales volume indicated is accurate and acknowledges any variance to this information could result in delayed and/or withheld settlement offunds and/or termination of merchant.E-COMMERCE MERCHANTS ONLYSERVICE PROVIDER:LIST ALL APPLICABLE URL'S FOR YOUR WEBSITE: IF E-COMMERCE, DO YOU USE A FULFILLMENT CENTER? YES NOIF YES, PLEASE LIST CONTACT INFORMATION:TOTALWHEN IS THE CARDHOLDER BILLED FOR PRODUCTS/SERVICES? ON ORDER SHIPMENTDELIVERY OF PRODUCTS: TIME OF SALE 1-3 DAYS 3-5 DAYS 5-15 DAYS 15 DAYS+DETAILED BUSINESS DESCRIPTION:DOES MERCHANT USE A FULFILLMENT HOUSE? YES NODOES YOUR SITE HAVE A SECURE CERTIFICATE? YES NO%%%100%A3PRINCIPAL #1OWNERS OR OFFICERS% OF EQUITY OWNERSHIP PRINCIPAL #2 % OF EQUITY OWNERSHIPSOCIAL SECURITY NUMBERDATE OF BIRTHTELEPHONE #SOCIAL SECURITY NUMBERDATE OF BIRTHTELEPHONE #RESIDENCE ADDRESSRESIDENCE ADDRESSCITY STATE ZIPCITY STATE ZIPA4REFERENCESTRADE REFERENCECONTACT ACCOUNT # TELEPHONE #TRADE REFERENCE CONTACT ACCOUNT # TELEPHONE #A5BANKING INFORMATIONNAME OF MERCHANT'S BANKROUTING/ABA #PLEASE INCLUDE A VOIDED CHECK OR BANK LETTERCONTACT BANK LOCAL TELEPHONE #DBA/CHECKING ACCOUNTIn accordance with the terms set out in the Terms and Conditions, transfer funds will be made to/from the account set forth in the enclosed voided check or bank letter.JUNE12HARBORTOUCH IS A REGISTERED ISO/MSP OF FIRST NATIONAL BANK OF OMAHA, 1620 DODGE ST., OMAHA, NE – FDICPAGE 2 OF 4
Page 1: Harbortouch POS Account Submission
Page 5 and 6: SECTION C (CONTINUED) — PLEASE SE
Page 7 and 8: ACH Authorization: The service char
Page 9 and 10: THIS SERVICE AGREEMENT is made on t
Page 11 and 12: 6.2 DISCLAIMER OF WARRANTIES AND LI

Harbortouch POS Account Submission Checklist - United Bank Card

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