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Sales Representative Application Form
22-April-24
I.Sales Representative/Subscriber Correspondence & Communication Background
Sales Representative Account Information
Contact First Name (Owner) Contact Last Name (Owner) User Email
Password Confirm Password
Password Hint Question Password Hint Answer
Mother's Maiden Name Confirm Mother's Maiden Name
Mother's Maiden Name Hint Question Mother's Maiden Name Hint Answer
Country Code Business Address City
Zip Code   State
Sales Rep. Phone (Direct) - -   Sales Rep. Fax No. (Direct) - - Sales Rep Cellular Phone - -
Corporate Business Details
Same as above        
Corporate Business Name   Corporate Code*
(* - Not required for New
Sales Representative)
Corporate Business Address  
City   Country code Corporate Phone (Toll Free) - -
State   Zip   Corporate Phone (Direct) - -
Employer Identification Number (EIN)       Corporate Fax No. - -
Sales Representative Home Details
Address City Country Code
State Zip
Driver's License Home Phone - - Social Security Number
- -
II. Sales Representative Billing Information
Transit /Routing/ABA #
 
Bank Name Account#  
Bank Phone # - - Bank Address   State  
City   Zip  

eQuotz® will initiate debit entries to your Bank Account on the 1st Business day of each month. If either date falls on a weekend or holiday, then debit entries shall be initiated the next preceding business day. In the event of an ACH Reject / Non Sufficient Funds, eQuotz® shall attempt two debits to collect for services rendered. There will be a $35.00 charge for each ACH Reject.

III. Visa / MasterCard / Sponsoring Information
Is the above company a registered ISO / MSP?  
If no, who is the registered ISO / MSP?
(If Other Please Enter)
 
Who are the sponsoring financial institution(s) for the MSP / ISO?   ISO / MSP Business Address:  
ISO / MSP City:   ISO / MSP State:   ISO / MSP Zip:   
ISO / MSP Business Phone (Toll Free) - - ISO / MSP Business Phone (Direct) - -  
IV. Company Background(Information will be shared with merchants)
When was the above company in section I founded?   How many employees are employed by the company?     What state are the articles of incorporation located?  
Personal Background (Information will be shared with merchants)
You are an   Have you ever been convicted of a felony?  
Have you ever been reprimanded or terminated by a sponsoring financial institution VISA USA, Inc. or MasterCard International, Inc. as a MSP, ISO or independent agent?  
How long have you representative or been employed by the above company?  Years     When did you begin Marketing / Selling merchant processing services?  
V. Merchant processing Demographics(Information will be shared with merchants)
Who is your primary settlement bank?
(If Other Please Enter )
  Who is your secondary settlement bank?
(If Other Please Enter)
 
Who is your primary authorization provider?
(If Other Please Enter)
    Who is your secondary authorization provider?
(If Other Please Enter)
 
Who is your primary settlement processor?
(If Other Please Enter)
  Who is your secondary settlement processor?
(If Other Please Enter)
 
Name of Organization Who provides customer support services?   What is their telephone number? - -       Number of merchants supported:    
Name of Organization Who provides Technical support services?   What is their telephone number? - -       Number of merchants supported:    
What percentage of all chargebacks are handled without merchant involvement?  %     What percentage of chargebacks are reversed back to the issuing bank on the 1st attempt?  %    
Are merchant processing fees & discount (Normally) deducted a month end?   Are processing expenses (Normally) calculated on gross credit card volume?  
How do merchants (Normally) receive retrieval requests?  
What is the Term of your Merchant Agreement?
 
What is the early termination fee $    
VI. Auction Options
Are there certain SIC codes where you do not want to pursue merchant opportunities?

(To Select Multiple Items press 'Ctrl' and 'Left Mouse click' on the item)
 
Which Countries do wish to see Merchant Bids From? (To Select Multiple Items press 'Ctrl' and 'Left Mouse click' on the item) Are there certain States where you do not want to pursue merchant opportunities?

(To Select Multiple Items press 'Ctrl' and 'Left Mouse click' on the item)
State
How long must a merchant be in business before you pursue them as an opportunity?   Year 
VII. Standard Merchant Swiped Fees You Charge Merchants
(All Fees Will Auto Populate Your Pricing Model. It will Be Necessary for You To Change Some of The Fees in the Pricing Model and Merchant Proposal)
Standard Sales Representative Bidding Template
Bundled Rate
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %   $     %     $     %     $    
Visa/MasterCard - Check / Signature Debit Card %     $     %     $     %     $    
Visa/MasterCard - Consumer Classic Rewards / World Cards %     $     %     $     %     $    
Visa/MasterCard - Check Card Rewards / World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %      $     %     $     %     $    
Discover - Check / Signature Debit Cards %     $     %     $     %     $    
Discover - Consumer Classic Rewards / World Cards %     $     %     $     %     $    
Discover - Check Card Rewards / World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %      $     %     $     %     $    
Amex - Check / Signature Debit Cards %     $     %     $     %     $    
Amex - Consumer Classic Rewards / World Cards %     $     %     $     %     $    
Amex - Check Card Rewards / World Cards %     $     %     $     %     $    
Interchange Pass Through
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %     $     %     $     %     $    
Visa/MasterCard - Check / Signature Debit Card %     $     %     $     %     $    
Visa/MasterCard - Consumer classic Rewards / World Cards %     $     %     $     %     $    
Visa/MasterCard - Check Card Rewards / World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %     $     %     $     %     $    
Discover - Check / Signature Debit Cards %     $     %     $     %     $    
Discover - Consumer Classic Rewards / World Cards %     $     %     $     %     $    
Discover - Check Card Rewards / World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %     $     %     $     %     $    
Amex - Check / Signature Debit Cards %     $     %     $     %     $    
Amex - Consumer Classic Rewards / World Cards %     $     %     $     %     $    
Amex - Check Card Rewards / World Cards %     $     %     $     %     $    
Other Fees Other Fees (continued) 
Application Fees $     Bin / ICA Percentage Fee %     Per Inquiry
Installation / Training $     Bin / ICA Transaction Fee $    Per Inquiry
Statement Fee $     Authorization Fee (Per Inquiry)
Customer Service Fee $     Visa $     
Minimum Discount $     Master Card $     
Membership Fee $     American Express $    
ACH $     Discover $    
Reporting $     EBT $    
Batch Settlement $     Dinner Club $    
Miscellaneous 1 - Percentage %     JCB $    
Miscellaneous 2 - Transaction $    
$    
Retrieval Processing $     $    
Chargeback Processing $     Enter(Pin Debit Auth Fee) $    
Account Changes & Maintenance $     Voice Auth (Touch Tone) $    
Return Item Fee $     Voice Auth (Operated Assisted) $     
PCI/PABP/DSS Annual Fee $     IRS / 1099 Reporting - Annual Fee $
PCI/PABP/DSS Monthly Fee $     IRS / 1099 Reporting - Monthly Fee $
VIII. Standard Merchant Non Swiped Fees You Charge Merchants
(All Fees Will Auto Populate Your Pricing Model. It will Be Necessary for You To Change Some of The Fees in the Pricing Model and Merchant Proposal)
Standard Sales Representative Bidding Template
Bundled Rate
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %     $     %     $     %     $    
Visa/MasterCard - Check / Signature Debit Card %     $     %     $     %     $    
Visa/MasterCard - Consumer classic Rewards / World Cards %     $     %     $     %     $    
Visa/MasterCard - Check Card Rewards / World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %     $     %     $     %     $    
Discover - Check / Signature Debit Cards %     $     %     $     %     $    
Discover - Consumer Classic Rewards /World Cards %     $     %     $     %     $    
Discover - Check Card Rewards /World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %     $     %     $     %     $    
Amex - Check / Signature Debit Cards %     $     %     $     %     $    
Amex - Consumer Classic Rewards /World Cards %     $     %     $     %     $    
Amex - Check Card Rewards /World Cards %     $     %     $     %     $    
Interchange Pass Through
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %     $     %     $     %     $    
Visa/MasterCard - Check / Signature Debit Card %     $     %     $     %     $    
Visa/MasterCard - Consumer classic Rewards / World Cards %     $     %     $     %     $    
Visa/MasterCard - Check Card Rewards / World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %     $     %     $     %     $    
Discover - Check / Signature Debit Cards %     $     %     $     %     $    
Discover - Consumer Classic Rewards /World Cards %     $     %     $     %     $    
Discover - Check Card Rewards /World Cards %     $     %     $     %     $    
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %     $     %     $     %     $    
Amex - Check / Signature Debit Cards %     $     %     $     %     $    
Amex - Consumer Classic Rewards /World Cards %     $     %     $     %     $    
Amex - Check Card Rewards /World Cards %     $     %     $     %     $    
Other Fees Other Fees (continued)
Application Fee $     Bin / ICA Percentage Fee %    Per Inquiry
Installation / Training $     Bin / ICA Transaction Fee $    Per Inquiry
Statement Fee $     Authorization Fee (Per Inquiry)
Customer Service Fee $     Visa $     
Minimum Discount $     Master Card $     
Membership Fee $     American Express $    
ACH $     Discover $    
Reporting $     EBT $    
Batch Settlement $     Dinner Club $    
Miscellaneous 1 - Percentage %     JCB $    
Miscellaneous 2 - Transaction $    
$    
Retrieval Processing $     $    
Chargeback Processing $     Enter(Pin Debit Auth Fee) $    
Account Changes & Maintenance $     Voice Auth (Touch Tone) $    
Return Item Fee $     Voice Auth (Operated Assisted) $    
PCI/PABP/DSS Annual Fee $     IRS / 1099 Reporting - Annual Fee $
PCI/PABP/DSS Monthly Fee $     IRS / 1099 Reporting - Monthly Fee $
IX. Standard Processor / Bank Swiped Fees Charged to You
(All Fees Will Auto Populate Your Pricing Model. It will Be Necessary for You To Change Some of The Fees in the Pricing Model and Merchant Proposal)
Standard Sales Representitave Bidding Template
Bundled Rate
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %    $   %    $   %    $  
Visa/MasterCard - Check / Signature Debit Card %    $   %    $   %    $  
Visa/MasterCard - Consumer classic Rewards / World Cards %    $   %    $   %    $  
Visa/MasterCard - Check Card Rewards / World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %    $   %    $   %    $  
Discover - Check / Signature Debit Cards %    $   %    $   %    $  
Discover - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Discover - Check Card Rewards /World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %    $   %    $   %    $  
Amex - Check / Signature Debit Cards %    $   %    $   %    $  
Amex - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Amex - Check Card Rewards /World Cards %    $   %    $   %    $  
Interchange Pass Through
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %    $   %    $   %    $  
Visa/MasterCard - Check / Signature Debit Card %    $   %    $   %    $  
Visa/MasterCard - Consumer classic Rewards / World Cards %    $   %    $   %    $  
Visa/MasterCard - Check Card Rewards / World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %    $   %    $   %    $  
Discover - Check / Signature Debit Cards %    $   %    $   %    $  
Discover - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Discover - Check Card Rewards /World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %    $   %    $   %    $  
Amex - Check / Signature Debit Cards %    $   %    $   %    $  
Amex - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Amex - Check Card Rewards /World Cards %    $   %    $   %    $  
Other Fees Other Fees (continued)
Application Fee $    Bin / ICA Percentage Fee %  Per Inquiry
Installation / Training $    Bin / ICA Transaction Fee $   Per Inquiry
Statement Fee $    Authorization Fee (Per Inquiry)&
Customer Service Fee $    Visa $      
Minimum Discount $    Master Card $      
Membership Fee $    American Express $   
ACH $    Discover $   
Reporting $    EBT $   
Batch Settlement $    Dinner Club $   
Miscellaneous 1 - Percentage %    JCB $   
Miscellaneous 2 - Transaction $   
$   
Retrieval Processing $    $   
Chargeback Processing $    Enter(Pin Debit Auth Fee) $   
Account Changes & Maintenance $    Voice Auth (Touch Tone) $   
Return Item Fee $    Voice Auth (Operated Assisted) $   
PCI/PABP/DSS Annual Fee $    IRS / 1099 Reporting - Annual Fee $
PCI/PABP/DSS Monthly Fee $    IRS / 1099 Reporting - Monthly Fee $
X. Standard Processor / Bank Non Swiped Fees Charged to You
(All Fees Will Auto Populate Your Pricing Model. It will Be Necessary for You To Change Some of The Fees in the Pricing Model and Merchant Proposal)
Standard Sales Representative Bidding Template
Bundled Rate
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %    $   %    $   %    $  
Visa/MasterCard - Check / Signature Debit Card %    $   %    $   %    $  
Visa/MasterCard - Consumer classic Rewards / World Cards %    $   %    $   %    $  
Visa/MasterCard - Check Card Rewards / World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %    $   %    $   %    $  
Discover - Check / Signature Debit Cards %    $   %    $   %    $  
Discover - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Discover - Check Card Rewards /World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %    $   %    $   %    $  
Amex - Check / Signature Debit Cards %    $   %    $   %    $  
Amex - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Amex - Check Card Rewards /World Cards %    $   %    $   %    $  
Interchange Pass Through
  Qualified Rate Standard Mark Up on Mid Qualified Transaction Standard Mark Up on Non Qualified Transaction
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Visa/MasterCard - Credit Card / Consumer Classic %    $   %    $   %    $  
Visa/MasterCard - Check / Signature Debit Card %    $   %    $   %    $  
Visa/MasterCard - Consumer classic Rewards / World Cards %    $   %    $   %    $  
Visa/MasterCard - Check Card Rewards / World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Discover - Credit Cards / Consumer Classic %    $   %    $   %    $  
Discover - Check / Signature Debit Cards %    $   %    $   %    $  
Discover - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Discover - Check Card Rewards /World Cards %    $   %    $   %    $  
  Rate Settled Per Item Rate Settled Per Item Rate Settled Per Item
Amex - Credit Cards / Consumer Classic %    $   %    $   %    $  
Amex - Check / Signature Debit Cards %    $   %    $   %    $  
Amex - Consumer Classic Rewards /World Cards %    $   %    $   %    $  
Amex - Check Card Rewards /World Cards %    $   %    $   %    $  
Other Fees Other Fees (continued) 
Application Fee $    Bin / ICA Percentage Fee %   Per Inquiry
Installation / Training $    Bin / ICA Transaction Fee $   Per Inquiry
Statement Fee $    Authorization Fee (Per Inquiry)
Customer Service Fee $    Visa $    
Minimum Discount $    Master Card $    
Membership Fee $    American Express $   
ACH $    Discover $   
Reporting $    EBT $   
Batch Settlement $    Dinner Club $   
Miscellaneous 1 - Percentage %    JCB $   
Miscellaneous 2 - Transaction $   
$   
Retrieval Processing $    $         
Chargeback Processing $    Enter(Pin Debit Auth Fee) $    
 Account Changes & Maintenance $    Voice Auth (Touch Tone) $    
Return Item Fee $    Voice Auth (Operated Assisted) $   
PCI/PABP/DSS Annual Fee $    IRS / 1099 Reporting - Annual Fee $
PCI/PABP/DSS Monthly Fee $    IRS / 1099 Reporting - Monthly Fee $
XI. Share with Your Bank / Processor / ISO
(All Fees Will Auto Populate Your Pricing Model. It will Be Necessary for You To Change Some of The Fees)
Select only one option
  What Percentage of the revenue do you Keep? %    
What Percentage of the "Partial & Non" Qualified Markup do you Receive?  %  
What Percentage of the "Partial & Non" Qualified Markup does your Processor charge you for Risk Assessment?   %  
XII. Features & Benefits (Information will be shared with Merchants)
 
XIII. Electronic Disclosures, Notices and Consent - eQuotz® Online Agreement
1 To receive disclosures, notices and this Agreement (including amendments) (the "Account Documents") in electronic form the following hardware and software requirements aply. You must have access to:
I IBM and Macintosh computer
II Internet access
III Internet browser with a security enabled browser that supports 128-bit encryption (Netscape Navigator 5 or Microsoft Internet Explorer 5)
IV A personal e-mail address
V [User ID] [Password]
2 You consent to receive all Account Documents electronically.
3 You may print the Account Documents by using the "print" button in your browser [the print key on the page where the Account Document is located] or downloading the Account Document to your desktop. Contact 847-323-2950 if you have questions.
4 At your request, we will provide you with a paper copy of the Account Documents at your request at no cost. Contact us at 847-323-2950.
5 You have the right to withdraw your consent and may require that we provide you with all Account Documents in paper form. Contact us at 847-323-2950 to withdraw your consent to receive electronic Account Documents.
6 Click the "I accept" button below to:
I Confirm your consent to receive Account Documents electronically
II Affirmatively demonstrate your ability to access the Account Documents in electronic form
III Acknowledge that you have accessed and read the Account Documents prior to signing this Agreement.
IV Agree to the terms of this Agreement; and
V Affix your electronic signature by checking "I accept" to show agreement to and signature on this Agreement


Click here to Review Agreement
 
Subscriber Internet Referral Agreement - eQuotz® Online Agreement
In consideration of the mutual promises herein, Subscriber agrees as follows to the terms and conditions set forth in the Subscriber Internet Referral Agreement.



 
 
    
eQuotz® Disclaimer
Notice to users of the eQuotz® service: eQuotz®, its owners, employees, officers and directors are not responsible or liable for the services provided as a part of this website. The Website is to bring together merchants and acquirers for prospective business arrangements. Accordingly, eQuotz® is not responsible for the information related to any merchant or acquirer, for any quotes or subsequent pricing or for the quality of any services provided by any subscriber or user of the eQuotz® website, either merchant or acquirer. Use of this site constitutes the agreement of the user to deal with the acquirer and to hold eQuotz®, its officers, directors and employees harmless from any claims of any nature whatsoever.
Thank You
We certainly appreciate you taking the time to visit and use the eQuotz® product. We are confident this experience will save you money and improve the quality of your merchant account processing. If you agree with us, we would be very grateful if you would pass along the eQuotz® name as a referral to one of your business associates. However, if you feel that we did not completely meet your expectation, we want to hear about it help@equotz.com. Again, thank you for Your business!