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Nelly wesley signatures

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Nelly wesley signatures

  1. 1. MERCHANT APPLICATION AND AGREEMENT FAX BACK To: _______________ or E-Mail BACK To: _______________ Sales Rep Telephone #: Fax #: N/A BUSINESS INFORMATION MERCHANT BUSINESS INFORMATION Name of Entity (Legal Name): Nelly Wesley Name of Business: Nelly Wesley Corporate / Billing Address: 2346 Haywood Avenue Location Address (No P.O. Box #): 2346 Haywood Avenue City: West Vancouver Prov: BC Postal Code: v7v1x7 City: West Vancouver Prov: BC Postal Code: v7v1x7 Telephone # (Landline): GST exempt: GST Tax ID: Telephone # (Landline): Fax: Time Zone: 604-913-2479 604-913-2479 How long in present business? Year: Months: 4 Email (Statement): Attention: Allan Lacoste Merchant Customer Service # (If MOTO/Ecomm): 604-913-2479 What descriptor would you like to appear on customer credit card statement? Vemma Products Previous Processor? Yes No Name of Previous Processor: OWNERS OR OFFICERS (Ownership must be equal to or greater than 50%) Title: Email address: Percent Ownership: 100% First Name: Last Name: Date of Birth: Home Address: 2346 Haywood Avenue City: West Vancouver Prov: BC Postal Code: v7v1x7 Home Tel. : 604-913-2479 SIN: 733038236 Driver Lic. : DL.2348967 Prov: BC Cell. #: Title: Email address: Percent Ownership: First Name: Last Name: Date of Birth: Home Address: City: Prov: Postal Code: Home Tel. #: SIN: Driver Lic. #: Prov: Cell. #: ELECTRONIC DEBIT / CREDIT AUTHORIZATION Please provide a pre-printed void business check or bank letter confirming your business account Transit # (ABA Routing) and Ac count# (DDA). By providing this information, you are authorizing the Bank to initiate EFT debit and credit transactions to said account in ac cordance with section 5.09 of the TOS. Bank ID: 1 Bank Transit Number: 7780 Account Holder Name: Wesley Group Networking Bank Account Number: 07788985-758 Bank Branch Postal Code: v7v1x7 Account Holder Name : DEFINITIONS: "Merchant Application" means this Merchant Application between Peoples Trust, Pivotal Payments Direct and Merchant. "Merchant Agreement" means this Merchant Application once approved and accepted by Peoples Trust together with the Terms of Service ("TOS") found at . I confirm that I have read and understood the TOS and agree to all statements. Merchant initials: PEOPLES TRUST DISCLOSURE MEMBER INFORMATION: Peoples Trust Company ("Peoples Trust") Important Peoples Trust Responsibilities: 1. Peoples Trust is the only entity approved to extend acceptance of Visa, MasterCard and Interac products directly to a Merchant. 2. Peoples Trust is responsible for educating Merchant on pertinent Visa, MasterCard, Interac operating regulations with which Merchant must comply. 3. Peoples Trust, not Pivotal Payments Direct must hold, administer and control all reserve funds derived from settlement. 4. Peoples Trust, not Pivotal Payments Direct ust hold, administer and control settlement funds for the Merchant. 5. Peoples Trust must be a principal (signor) to the Merchant Agreement Important Merchant Responsibilities: 1. Complying with cardholder data security and storage requirements. 2. Maintaining fraud and chargebacks below established thresholds. 3. Reviewing and understanding the TOS located on above website. 4. Complying with Visa, MasterCard, Interac operating regulations. The responsibilities listed above do not supersede terms of the TOS but are provided to ensure the Merchant understands some important obligations of each party and that Peoples Trust, as the Visa/MasterCard/Interac member, is the ultimate authority should the Merchant have any problems. Signature 1: Title: Date: 2014-05-18 Signature 2: Title: Date: 2014-05-18 BUSINESS INFORMATION (CONT'D) Agent Office / Inside Sales Rep Name: Allan Lacoste URL: S.C.I: Product or Service being offered: Vemma Products Nelly Wesley 1956-06-09
  2. 2. BUSINESS PROFILE SALES PROFILE Type of Ownership : Sole Proprietorship Government Partnership Limited Liability Corporation Non-Profit Merchant Type: Retail Internet Service Restaurant MO/TO Lodging Other Home Based TRADE / REFERENCES 1 TRADE / REFERENCES 2 Company Name: Company Name: Address: Address: Contact : Title : Contact : Title : Telephone : Ext.: Telephone : Ext.: SEASONALITY Do you operate Seasonally? Yes January February March April May June July August September October November December DATA SECURITY & PCI COMPLIANCE 1. Do you store credit card numbers? 2. Do you use a third party application that transmits or processes cardholder data? 3. If credit card payment information is taken over the Internet is payment channel encrypted by SSL or better? 4. If merchant is an e-commerce merchant, is an SSL Merchant Certificate utilized? If yes, please provide the following: N/A Yes NO N/A Yes NO N/A Yes NO N/A Yes NO N/A Yes NO If yes, please provide the following: Merchant Certificate: Certificate Issuer: Exp. Date: Is Certificate? Individual Shared * Merchant agrees to pay a quarterly data security fee of $ per terminal in consideration of Pivotal Payments moni toring, advising and implementing any Bank or card-Association mandated changes to regulations SITE SURVEY Please complete as many of the following questions that are relevant to your business type. Not all questions are applicable to all business types. Please indicate Not-Applicable ( N/A ) in such cases. 1. % of total card sales: Business to business 5% + Business to consumer 95% = 100% 2. How long after payment is product delivered or service fulfilled? or 0-7 days 100% + 8-14 days 0% + 15-30 days 0% + over 30 days0% = 100% 3. Visa/MasterCard/Discover card sales are charged to the card on: Date of order Date of delivery Other (specify): : 4. Who performs product / service fulfillment? My Company Vendor Other If vendor or other, add: Name: Herbalife Contact name: Address: City: State/Province: Zip/Postal Code: Phone: 5. If your product is shipped, what delivery method do you use? (Ex. Regular Mail, Fedex, local delivery service): Fedex 6. Does your business charge recurring billings to customers? N/A Yes No 7. Does any of your billing or marketing strategy involve negative response, or automatic billing? N/A Yes No If yes, please explain: 8. Do you require deposits? N/A Yes No If yes, % of total sale: % OR Flat fee: $ Is final payment due before fulfillment N/A Yes No . If yes, how many days before final delivery? 9. Do you have a refund policy, and if so, what is it? Yes,30 days return policy 10. What are your product/service guarantees or warrantees (if applicable)? If for any reason a retail customer is not satisfied with any Herblife product, we offer a full refund, excluding shipping charges, if requested within 30 days of receipt of product. 11. Advertising method: Internet Catalog Direct Mail Phone book TV / radio Newspaper / Magazine Other (specify): I confirm that i have read and understood all services subscribed and their associated rates and fees, as well as Terms of Service found at SCHEDULE A VISA / MASTERCARD SALES PROFILE (be as accurate as possible or delays will occur in processing the application) Card Swipe: % VISA MASTERCARD Debit Keyed (In person): % Monthly Volume: $ 2000 $ 400 $ N/A MO/TO: 100% Internet: 0% (includes calculation of all 4 categories) Total = 100% Average Ticket: $ 39.95 $ 39.95 $ N/A VISA/MASTERCARD PROCESSING VISA Mastercard Credit Card Processing Minimum: $ / Month Qualified Transactions $2.39 $2.39 $2.39 % Mid-Qualified Transactions % 0.00 % % 0.00 % Non-Qualified Transactions $4.35 $4.35 $4.35 % Cost Plus % % % % Quoted Merchant Rates may be subject to International Assessments on foreign issued cards. Associated Fees Online Reporting / Web Fee $ / Month Authorization Fee $ / Authorization Clearing Fee $ / Transaction Statement / Service Fee $ / Month Batch Fee $ / Batch Card Brand Fee on all Credit Card % Transaction Volume MasterCard Cross Border Assessment Fee for Foreign Card Volume % OTHER CARD TYPES Existing Account New Account
  3. 3. SE # Auth. Fee Monthly Volume Rate Per Item AMEX (10 digits) $ .10 AMEX Connectivity Fee: $ / month DINERS CLUB (10 digits) $ .10 JCB $ .10 DEBIT SALES PROFILE Monthly Volume: $ (be as accurate as possible or delays will occur in processing Average Ticket: $ the application) DEBIT PROCESSING Debit Acceptance Debit Surcharge Debit Card Processing Minimum: $ / Month Per transaction fee $ Debit: $ / Authorization Transaction Fee: $ / Transaction SCHEDULE B E-COMMERCE SERVICES Standard VT Recurring VT Web Commerce Suite Application Fee $64.95 $ $ Monthly Gateway Fee $54.95 $54.95 $ Fee per transaction $0.25 $ $0.25 CONFIGURATION PARAMETERS Tip Function Yes No Retrieval Fee $ 10.00 / Transaction Debit Auto Settle Yes No If yes, what time? Chargeback Fee $ 25.00 / Occurrence Password Protect refunds? Yes No Cash Back Fee Amount $ _ Account Setup Fee $ 0.00 Allow Debit Cash Back Yes No Anniversary Fee $ 99.95 / Year MCP Yes No Application Fee $ 0.00 / Item DCC I confirm that i have read and understood all services subscribed and their associated rates and fees, as well as Terms of Service found at AGREEMENT PERSONAL GUARANTY The undersigned individually, absolutely and unconditionally guarantees to Pivotal Payments Direct ("PPD") the prompt payment of all amounts due under this Merchant Agreement (i.e. this Application and the TOS) including all attorney's fees and costs associated with enforcement of this personal guaranty. PPD shall not be required to proceed against Merchant or enforce any other remedy before proceeding against the undersigned. This is a continuing guaranty and shall bind the undersigned's heirs, successors and assigns. The undersigned consents to any extension or modification of this application and TOS. The release or compromise of any obligation of Merchant or an other obligors/guarantors shall not release the undersigned from its obligations under this personal guaranty. Signature #1 Title Print Name Nelly Wesley Date 2014-05-18 Signature #2 Title Print Name Nelly Wesley Date 2014-05-18 ACKNOWLEDGEMENT. Merchant certifies that all information set forth in this Merchant Application is true and correct and that it has read and agreed to all terms of the Terms of Service (TOS) located at, incorporated herein by reference. Merchant agrees and acknowledges that the below signature serves as consent to the Equipment Lease Agreement found in the Third-Party Agreements section of the TOS, if selected above. This Merchant Application together with the TOS constitute the Merchant Agreement. Merchant, its representative(s) and each person whose information is on this Merchant Application authorizes PPD, Peoples Trust and their agents prior to acceptance of this application and from time to time: (i) to investigate the individual and business history, creditworthiness and background of Merchant, each such representatives and any other officers, employees, partners or owners of Merchant (collectively Merchant Principals); (ii) to obtain credit reports, financial information or other background reports on each of the Merchant Principals; (iii) to use personal information provided in this Merchant Application to facilitate provision of services hereunder; (iv) to use and share such personal information with financial institutions, payment card issuers, credit agencies and similar agencies for reporting purposes and for investigating fraudulent or suspicious activities regarding Merchant account. Merchant agrees to all the terms of this Merchant Application and the TOS. Merchant acknowledges that this Merchant Application and the TOS shall not take effect until Merchant has been approved by PPD and Peoples Trust as evidenced by the issuance of a merchant identification number. By signing below, I represent that I have read and am duly authorized to sign and submit this Merchant Application for the above business (Merchant) and that I have read and agreed to the terms of the TOS. MERCHANT: PEOPLES TRUST COMPANY (BANK): Principal #1 Signature X: By: Print Name: Nelly Wesley Date:2014-05-18 Name and Title: MERCHANT: PIVOTAL PAYMENTS DIRECT CORP.: Principal #1 Signature X: By: Print Name: Name and Title: Date:
  4. 4. No Image Uploaded This check identifies the account from which Pivotal Payments Direct is authorized to initiate credit and debit entries as per the Pre-Authorized Debits (PAD) section in the Merchant Agreement. *** SECTION BELOW TO BE COMPLETED ONLY IF THE COMPANY NAME IS NOT PRINTED ON THE VOID CHECK *** MERCHANT INFORMATION AND AUTHORIZATION I hereby authorize my bank (referenced above) to confirm to Pivotal Payments Direct that this check is linked to an active bank account. Company Name: Nelly Wesley Name of Signing Officer: Nelly Wesley Merchant Name: Nelly Wesley Signature: Date: 2014-05-18 IP Address: BANK CONFIRMATION (FOR BANK USE ONLY) Attention: Dear Sir/Madame, our mutual client has applied to Pivotal Payments Direct for merchant services. Kindly sign and stamp below (both are required) in order to confirm that the account above is active and valid. Once completed please return by fax to: Bank Representative Name: Phone # : Signature: Powered by TCPDF (