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Merchant Services Application

  • Equipment Finance Application
  • Working Capital Application
  • Merchant Services Application

All Fields Are Required Unless Otherwise Indicated. Any Incomplete Or Inaccurate Information Will Delay The Processing Of Your Application And May Result In A Decline.

  • Merchant Business Information

  • Section 2 Beneficial/Control Ownership Information

    To help the government fight financial crime, Federal regulation requires certain financial institutions to obtain, verify, and record information about the beneficial owners of certain legal entity customers. Legal entities can be abused to disguise involvement in terrorist financing, money laundering, tax evasion, corruption, fraud, and other financial crimes. Requiring the disclosure of key individuals who own or control a legal entity (i.e., the beneficial owners) helps law enforcement investigate and prosecute these crimes.
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  • 7. SIGNATURE(S)

  • IMPORTANT MEMBER BANK RESPONSIBILITIES: (1) 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 on pertinent Visa Operating Regulations with which Merchants 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 RESPONSIBILITIES: (1) Ensure compliance with cardholder data security and storage requirements. (2) Maintain fraud and chargeback below thresholds. (3) Review and understand the terms of the Merchant Agreement. (4) Comply with Operating Regulations. The responsibilities listed above do not supersede the terms of the Merchant Agreement and are provided to ensure the Merchant understands some important obligations of each party and that the Visa Member (Acquirer) is the ultimate authority should the Merchant have any problems.

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  • SECTION 4 BUSINESS PROFILE AND ASSUMPTIONS

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  • Section 5 Compliance Information

  • All merchants must comply with the Payment Card Industry Data Security Standard ("PCI DSS"). Merchant is required to maintain the security of card data and to comply with the requirements of the PCI DSS. Merchant must validate its compliance with the PCI DSS and provide NPC with evidence that Merchant (a) has successfully completed a Self Assessment Questionnaire and scan(s), if applicable, and (b) is compliant with the PCI DSS. NPC has created the PCI Program (the "PCI Program") to assist merchants in securing card data and complying with PCI DSS. You are enrolled in the PCI Program and the applicable fees will be assessed in accordance with the terms of the PCI Program. Information on the PCI Program is set forth in Section 15 of the Terms and Conditions and the applicable fees are set forth in Section 8 of this Application. All gateway or other vendor supplied software must be compliant with the Payment Application Data Security Standard rules ("PA DSS").

  • SECTION 6 MERCHANT BANK ACCOUNT INFORMATION

    In accordance with the terms set out in the Merchant Processing Agreement, funds will be transferred to/from the account as delineated. If nothing is checked, MERCHANT will receive Premium ACH. ACH can be performed by the following entities: Member Bank, NPC or any authorized agent of NPC or any Third Party Service Provider with whom you have contracted. *Subject to special approval.
  • Any ACCOUNT NUMBER indicated must be a valid account number for handling ACH deposits and withdrawals. If more than one account is indicated, account #1 will be used for Sales.

Western Financial

1403 North Batavia St., Ste. 203
Orange, CA 92867
(800) 385-5290

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Fees

Debit Adjustment Fee $5.00/Adjustment Paper Statement Fee $0.00
Dialpay Transaction Fee $0.55/Transaction Technical Support Calls $0.00
Chargeback Fee $12.00/Chargeback Customer Services Calls $0.00
Retrieval Fee $5.00/Retrieval Merchant Monthly Minimum $15.00
Batch Fee $0.07/Batch Welcome Kit $6.50
Online Statements and Reporting $0.50/mo ACH/DBA Change Fee $5.00
Voice Authorization $1.35/Attempt Merchant Training (Only By Request) $15.00
Online Payment Processing Merchant Download¹ $14.00/Download
– One-Time Activation $59.00 PCI Program $55.00/yr
– Gateway Hosting Fee $9.95/mo PCI Non-Compliance Fee $25.00/mo
– Transaction Fee $0.05/Transaction (+ front end transaction fee) Voyager 3.60% + $0.15
– Batch Fee $0.07/Batch Wright Express (WEX) 3.50% + $0.15
Wireless POS ACH Fee $0.02/ACH
– One-Time Activation $40.00/Terminal ACH Reject Fee $25.00
– Gateway Hosting Fee $17.95/Terminal/mo Electronic Benefit Transfer (EBT)
– Transaction Fee $0.09/Transaction (+ front end transaction fee) – Transaction Fee $0.05/Transaction
Mobile POS – EBT ACH $3.00
– Monthly Hosting Fee $9.95/mo – EBT Adjustments $5.00
– Transaction Fee $0.12/Transaction (+ front end transaction fee) Credit Tier II Surcharge 0.05%
Micros Transaction Fee $0.05/Transaction (+ front end transaction fee) Advantage Buyer Program $19.95/mo
Address Verification Fee $0.02/Verification
¹ Does not apply to an initial download of a newly-boarded merchant