Stored Value Solutions Profit Center Form Please complete all sections of the form. Shift4's forms are easiest to use with Adobe Reader 8.0 or higher. Click here http://www.adobe.com to obtain a FREE upgrade at the Adobe website. Profit Center Information Profit Center Name (35) Address 1 (35) Address 2 (35) City (22) State (2) Zip (5) Telephone (10) Processor Specific Information Merchant ID (11) Store Number (10) Division Number (5) Split Tender* *Off - insufficient balance will return as declined. *On - will get an authorization for remaining card balance. Gift Card Information Card Range Lower (25) Card Length * Card Range Upper (25) Luhn *These fields are non-variable, please select from pull-down option. © 2009 Shift4 Corporation The Shift4 and DOLLARS ON THE NET logos are trademarks of Shift4 Corporation The Stored Value Solutions logo is a trademark of Stored Value Solutions IND87045FM-R072909 Public Document
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