CheddarGateway Payment Gateway Setup Form
CheddarGateway Features
(for merchants who already have a merchant account)
‹ Merchant Interface Complete return by email to [email protected]. Attach a company =60+,+JOLJR)LZ\YL[VJVTWSL[L[OL4LYJOHU[(JJV\U[*VUÄN\YH[PVU
‹ Virtual Terminal/Batch Upload Information section.
‹ )HZPJ9LJ\YYPUN)PSSPUN ‹ 3VHKIHSHUJPUN:`Z[LT Company Information
Date: ____________________________________ (mm/dd/yyyy)
‹ Real-time Reports ‹ 8\PJR)VVRZ0U[LNYH[PVU ‹ Virtual Point of Sale (VPOS) Company Name: ____________________________________
Address: ____________________________________________
City, State/Province, Zip Code
____________________________________________________
Phone: ( ____ ) ______________________________________
‹ PCI Compliant Customer Vault ‹ 7*0*VTWSPHU[5L[^VYR:JHUUPUN ‹ 9PZR4HUHNLTLU[-YH\K7YV[LJ[PVU ‹ Certify PCI™ ‹ Data Decryption Fax: ( _____) _________________________________________
‹ Electronic Checks Email: ______________________________________________
‹ 0U[LNYH[PVU(70 Website Address: ____________________________________
Business Type (Circle One):
*VYWVYH[PVU33*:VSL7YVWYPL[VY7HY[ULYZOPW5VU7YVÄ[;Y\Z[
Date Established: Month ____________ Year ___________
Description of Products/Services Sold:
________________________________________________
Company Tax (EIN) or Social Security #: ________________________________________________
Company Contact: ________________________________
IT/Technical Contact: ______________________________
7YVJLZZPUN4L[OVK! ___ e-Commerce______ 46;6 _____ Retail
‹ QuickClicks™
Requested Add-On Services:
✔
______________ Electronic Checks_____________ Customer Vault___________ iSpy Fraud_______________ Retail Payments VPOS
*VYWVYH[L6MÄJLY6^ULY7YPUJPWHS0UMVYTH[PVU
Name (First, MI, Last): ______________________________________________________________________________ Title: __________________________________________ Date: _____________________________________________
Phone: _______________________________________ Email: _____________________________________________
4LYJOHU[(JJV\U[7YVJLZZVY*VUÄN\YH[PVU0UMVYTH[PVU
Please provide the account information for ONE processor that is associated with you Merchant Account. 0M`V\OH]LHU`X\LZ[PVUZYLNHYKPUN^OPJO7YVJLZZVY5L[^VYR`V\Y4LYJOHU[(JJV\U[\ZLZWSLHZLJVU[HJ[
your Merchant Services provider.
First Data Corporation (FDC) - Nashville Platform
Merchant Account Bank or Acquire Name: ____________________________________________________________
Merchant ID (MID): ______________________________________________________________________KPNP[Z
Terminal ID (TID): _______________________________________________________________________ KPNP[Z
First Data Corporation (FDCO) - Omaha Platform
Merchant Account Bank or Acquire Name: ____________________________________________________________
Merchant ID (MID): ____________________________________________________________________ KPNP[Z
ELAVON (Formerly Nova Information Systems) - NOVA Platform
Merchant Account Bank or Acquire Name: ____________________________________________________________
Bank BIN/Terminal BIN #: ___________________________________________________________________KPNP[Z
Terminal ID (TID): _________________________________________________________________________ KPNP[Z
Vital (VisaNet)
Merchant Account Bank Acquirer Name: _____________________________________________________________
Acquirer BIN: ______________________________________________________________________________KPNP[Z
*H[LNVY`*VKL! ___________________________________________________________________________ KPNP[Z
(NLU[)HUR5\TILY! _______________________________________________________________________ KPNP[Z
Merchant Number: ________________________________________________________________________ KPNP[Z
(NLU[*OHPU5\TILY! ______________________________________________________________________ KPNP[Z
Store Number: ____________________________________________________________________________ KPNP[Z
Terminal Number (TID): _____________________________________________________________________ KPNP[Z
Global
Merchant Account Bank or Acquire Name: ____________________________________________________________
Acquirer Institution ID (Bank ID)#: ____________________________________________________________________
Merchant ID (MID): _________________________________________________________________________________
Paymentech
Merchant Account Bank or Acquire Name: ____________________________________________________________
Client Number: ____________________________________________________________________________KPNP[Z
Merchant # (Gensar #): ____________________________________________________________________ KPNP[Z
Terminal Number (TID): _____________________________________________________________________ KPNP[Z
Complete and return by email to [email protected]
Attach a company VOIDED check.