Mx Advantage Form Merchant Suite – Priority CC Terminal 125 Off

Step 1

Location Name & Address

Location Name (DBA) *

Street (PO Box not allowed) *

City *

State *

Postal Code *

Country *

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Step 2

Location Details

Business Established *

Market Segment *

Industry Type *

Product/Services *

Location Phone *

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Step 3

Legal Name & Address

Client Legal Entity Name *

Same as Location Address

Entity Street *

City *

State *

Postal Code *

Country *

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Step 4

Legal Details

Legal Entity Type *

Legal Entity Email *

State of Organization *

Country *

Entity Formation Date *

Tax ID Type **

Tax ID *

* Sole Proprietor or Individual Legal Entity Type must provide his/her SSN/EIN (or ITIN).

Prior Bankruptcy *
Yes
No

Discharge Date *

Discharge Date

NOTE: Failure to provide accurate information may result in a withholding of merchant funding per IRS regulations.
(See Part III, Section A.3 of your Program Guide for further information)

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Step 5

Ownership

Owner 1

Owner Name & Address

First Name *

Last Name *

U.S. Citizen *
Yes
No

Same as Location Address

Same as Legal Address

Home Address (PO Box not allowed) *

City *

State *

Postal Code *

Country *

Owners Details

Job Title *

Date of Birth *

Email Address Email *

Phone Number *

Control Person** *
Yes
No

All applications must have at least one Control Person.

Guarantor *
Yes
No

% of Ownership* *

** A Control Person includes an executive officer or owner with authority to control, manage, and direct the business of Applicant (e.g., a CEO, CFO, COO, Managing Member, General Partner, President, Vice President, or Treasurer) or any other individual with authority to perform such functions. The Control Person may also serve as the personal guarantor.

Identification Details

SSN *

Identification Type *

For Foreign Persons: Passport Number and Country of Issuance, or other similar identification number required.

* Each individual who owns, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, 25% or more of the equity interests of the Client, or who is the Client's sole proprietor, must be added.

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Step 7

Card Account Features

Accept American Express (OptBlue)

Enabled

Decline Service

Accept Discover Full Acquiring (MAP)

Enabled

Decline Service

Accept Mastercard Credit

Enabled

Decline Service

Accept Mastercard Debit

Enabled

Decline Service

Accept PIN Debit

Enabled

Decline Service

Accept Visa Credit

Enabled

Decline Service

Accept Visa Debit

Enabled

Decline Service

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Step 8

Card Account Pricing

Transaction Fees

Transaction Method - Card Present

Card Present

2.60%

Percent (%)

Transaction Method - Card Present

Card Not Present

3.50%

Percent (%)

Card Network Fees

Card Brand Fees

$0.00

Pass-Through All Costs ($)

Other Processing Fees

Cancellation

Early Termination

$495.00

Per Event ($)

Recurring

Minimum Fee, Monthly, Approval Month

$19.95

Per Event ($)

Recurring

Service, Monthly, Approval Month

$9.95

Per Event ($)

Recurring

Industry Compliance, Monthly

$14.95

Per Event ($)

Non-Compliance

TIN

$24.95

Per Event ($)

Card Exception

Chargeback Retrieval Request

$30.00

Per Event ($)

Non-Compliance

PCI DSS

$39.95

Per Event ($)

Card Exception

Chargeback

$30.00

Per Event ($)

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Step 9

Card Account Billing

Billing Account

Routing # *

Account # *

Account Type *

Funding Account

Same as Billing Account

Routing # *

Account # *

Account Type *

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Step 11

MX Merchant Pricing

App Fees

MX Base

$0.00

Per Event ($)

MX Advantage

$19.95

Per Event ($)

QuickBooks

$24.99

Per Event ($)

MX B2B

$19.95

Per Event ($)

ControlScan

$0.00

Per Event ($)

MX Account Updater

$25.00

Per Event ($)

MX Insights

$14.95

Per Event ($)

MX Retail

$24.95

Per Event ($)

MX Invoice

$14.95

Per Event ($)

MX Developer

$0.00

Per Event ($)

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Step 12

Passport Account

Get your Passport account now!

Simple pricing with no hidden charges.

No setup fees or minimum balance requirements.

FDIC insured accounts.

FDIC insured* account

Pass-through FDIC insurance on accounts.

Pre-Approved Capital

Unlock pre-approved capital. No credit checks or lengthy paperwork.

Debit Card

Corporate debit cards for you and your employees.

Vendor Payments

Online bill and recurring electronic payments.

Managed Services & Support

We enable you to handle every aspect of commerce.

Collect-Store-Send

Recurring Payments, ACH, Check, Virtual Cards, and more.

* Pass-through FDIC insurance is subject to FDIC rules.

*Your Billing and Funding Account will be updated to Passport Account. Reach out to your acquiring partner to request for Faster Funding.

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Step 13

Documents

No documents are required for this application. You're all set.

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Location Name & Address

Location Details

Legal Name & Address

Legal Details

Ownership

Owner 1

Owner Name & Address

Owners Details

Identification Details

Card Account General

Card Not Present Questionnaire

Billing Method

MOTO Supporting Documents

Supply/Fullfillment Vendor(s)

Vendor Agreement

Card Account Features

Enabled

Enabled

Enabled

Enabled

Enabled

Enabled

Enabled

Card Account Pricing

Transaction Fees

Card Network Fees

Other Processing Fees

Card Account Billing

Billing Account

Funding Account

MX Merchant Features

Enabled

Enabled

Enabled

Enabled

Enabled

Enabled

Enabled

Enabled

Enabled

Enabled

MX Merchant Pricing

App Fees

Passport Account

Get your Passport account now!

Documents