Authorized Merchant Packet 2010 - SRN Communications · PDF file ·...
Transcript of Authorized Merchant Packet 2010 - SRN Communications · PDF file ·...
PCS Wireless – Corporate 11 Vreeland Rd
Florham Park, NJ (973) 805-7400 Tel
www.pcsww.com
Authorized Merchant Packet 2010
Contractual Agreement Commission Rates Merchant Application
Please fax the following to (973) 301-0971 or email to [email protected]
Completed & Signed Application
Resale Tax Certificate
Preprinted Business Check or Bank letter with both routing and account number
PCS Wireless – Corporate 11 Vreeland Rd
Florham Park, NJ (973) 805-7400 Tel
www.pcsww.com
WEBPOS & BACKOFFICE LOGIN
WebPos
https://webpos.payspot.com/pcs BackOffice http://backoffice.payspot.com PaySpot Customer Service (800) 983-9385 PCS Email [email protected]
Merchant Agreement (rev. 10/07)
Merchant Agreement
Account ID#:____________Terminal ID#:____________IBO Username:__________________
Referring Agent:______________________ Referring Account #:_______________________
Merchant Contact Information
Merchant Name:
Street Address:
City State Zip
Office # Fax # Cell#
E-mail Address Contact Person
State Sales Tax # Please attach a copy of your RTC
Bank Name: Acct# Routing#
***Please attach preprinted business check***
PIN Wizard Access Requested: yes no Terminal Request: yes no
TO BE COMPLETED BY MERCHANT (use additional sheet, if necessary)
Requested [p]inWizard identification:
User Name:
MERCHANT BANKING INFORMATION AND ACH AUTHORIZATION (MUST INCLUDE VOIDED CHECK): This Merchant Agreement
(“Agreement”) is between PaySpot, Inc. (“Company”) and "Merchant" listed above. To accommodate electronic access for settlement, Merchant does
hereby authorize and instruct Company to access Merchant's designated depository account and to initiate credit and/or debit entries by bank wire,
payment order or Automated Clearing House transfer and to authorize the banking institution ("Depository") named above to block or to initiate, if
necessary, reversing entries and adjustments for any original entries made to the depository account indicated above and to authorize Depository to
provide such access and to credit and/or debit or to block the same to such account. This authorization is without respect to the source of any funds in
the depository account, and this authority shall remain in full force and effect until Company has received written notification from Merchant of its
termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it. In order to insure that
transactions are properly handled, a specimen-voided check is attached. Your signature acknowledges that you are authorized to execute this
Agreement, are a signatory on the attached business check and have read and understand all information contained herein, the terms and conditions and
any addenda, amendments, or attachments, all of which are incorporated into this Agreement.
[p]inWizard: At Merchant’s request, Company will provide internet access to Merchant by means of Company’s [p]inWizard application that will
enable Merchant to purchase PINs for various prepaid services utilizing the systems and software operated by Company. Merchant agrees to
exclusively use Company’s [p]inWizard system for the internet purchase, resale and further distribution of PINs for prepaid services of any type.
Merchant agrees that Merchant is responsible for the security of assigned User Names and Passwords utilized to access Company’s [p]inWizard system
and agrees to pay Company for all PIN purchases made utilizing Merchant’s assigned User Names and Passwords. Company agrees to establish
purchase limits within its system upon Merchant’s written request. Merchant agrees that it is purchasing Company’s products (“PaySpot Products”) for
resale to end-user customers of prepaid services and that Merchant is wholly responsible for any and all sales tax obligations on all products purchased
from Company.
Investigative Consumer Report: An investigative or Consumer Report may be made and obtained in connection with this Agreement. Merchant
authorizes Company or any credit reporting agency engaged by it to investigate the references given or any statements or data obtained from Merchant
or any undersigned principal for the purposes of this Agreement.
ISO Agreement (rev. 10/07) PaySpot, Inc. Confidential Information
EXHIBIT E
Credit Application Information
Legal Business Name: Tax Id:
Billing Address: City: State: Zip:
Telephone #: Fax#:
Accounts Payable Contact: Payables Phone #:
Company Email Address: Payables Email Address:
Merchant ‘Doing Business As” Name:
Location Address: City: State: Zip:
Telephone #: Fax#:
Primary Contact: Email Address:
Type of Company: Corporation Sole Proprietor LLC Partnership Joint Venture Other
If other, please explain:
State of Organization: Principle Place of Business:
Dun & Bradstreet #:
Requested Credit Line: No. of Years in Business:
Principal Information
Name: Title: Percentage of Ownership:
Residence Address: City: State: Zip:
Home Telephone: Social Security #: Date of Birth:
Driver’s License #: State:
Name: Title: Percentage of Ownership:
Residence Address: City: State: Zip:
Home Telephone: Social Security #: Date of Birth:
Driver’s License #: State:
Company President: Company CFO:
Trade References
Company Name: Phone #:
Address: Fax #:
Email Address: Account #:
Company Name: Phone #:
Address: Fax #:
Email Address: Account #:
Company Name: Phone #:
Address: Fax #:
Email Address: Account #:
Bank Account Information
Bank Name: Phone #:
Address: Fax #:
Account #: ______________________________________Contact Name: ___________________________________________
An investigative, consumer or commercial report may be made in connection with this application. The undersigned authorizes PaySpot or any credit
reporting agency employed by it to investigate its personal and business history and of its principals, partners, stockholders and members and obtain
credit bureau reports for each for the purposes of this Agreement.
Acceptance:
Authorized Signing Officer: Date:
Print Name & Title:
Product Merchant Percent Category
Boost Pins 4.00% Wireless
Boost RTR 10.00% Wireless
Boost RTR Unlimited $2.00 Wireless
ATT / Cingular Universal 14.50% Wireless
T-Mobile 13.50% Wireless
Verizon 6.50% Wireless
Virgin Mobile 5.00% Wireless
H2O 10.00% Wireless
Simple Mobile 8.00% Wireless
TracFone 9.50% Wireless
Tuyo Mobile 13.00% Wireless
Cricket By Week 9.50% Wireless
Cricket PayGo 8.50% Wireless
Net 10 9.50% Wireless
O2 GSM 12.50% Wireless
Page Plus 13.50% Wireless
Locus GSM 12.50% Wireless
Movida 8.50% Wireless
STI Mobile 11.50% Wireless
*By signing I agree to the above rates for the products being provided to me by PCS Wireless through Epay
Business Name Date
Name Signature
Agent Signature DateFOR AGENT USE ONLY
Additional Products & Discounts (Exhibit A)
*I, undersigned, hereby understand and agree that I am requesting that this terminal be placed by Epay, Inc. pursuant to my signed
Equipment Placement Contract on File, and agree to abide by the terms described therin.
1. Write VOID across the business check
2. Tape the business check over this box
3. Fax this Agreement to PCS Wireless @ (973) 301-0975 or email to [email protected]
Revised 07/2000, Page 1 of 4
TID#: 909000______________________ -OR - Agent username: _________________________________
UNIFORM SALES & USE TAX CERTIFICATE MULTIJURISDICTION
The below-listed states have indicated that this form of certificate is acceptable, subject to the notes on pages 2 - 4. The issuer and the
recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may
change from time to time.
Issued to Seller: PaySpot, Inc.
Address: 4601 College Blvd., Suite 300, Leawood, KS 66211
I certify that: is engaged as a registered
Name of Firm (Buyer): Wholesaler ________________________
Retailer ___________________________
Address Manufacturer ______________________
Seller (California) ___________________
Lessor (see notes
on pages 2 - 4) _____________________
Other (Specify) _____________________
and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such
purchases are for wholesale, resale, ingredients or components of a new product or service1 to be resold, leased, or rented in the
normal course of business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following:
Description of Business: ___________________________________________________________________________
General description of tangible property or taxable services to be purchased from the seller:
Mobile phones, wireless PINs, long distance phone cards
State State Registration, Seller's State State Registration, Seller's
Permit, or ID Number Permit, or ID Number
of Purchaser of Purchaser
AL2 _____________________________ MO13 _____________________________
AR _____________________________ NE14 _____________________________
AZ22 ____________________________ NV _______________________________
CA 3 ____________________________ NJ ________________________________
CO 1 ____________________________ NM 1,15 ____________________________
CT4 _____________________________ NC25 ______________________________
DC5 _____________________________ ND _______________________________
FL 23_____________________________ OH26 ______________________________
GA6 _____________________________ OK16 ______________________________
HI 1,7 ____________________________ PA27 ______________________________
ID ______________________________ RI 17 ______________________________
IL 1,8 ____________________________ SC ________________________________
IA ______________________________ SD 18 ______________________________
KS ______________________________ TN _______________________________
KY 24_____________________________ TX19 ______________________________
ME9 ______________________________ UT _______________________________
MD 10 _____________________________ VT _______________________________
MI 11 ______________________________ WA 20 _____________________________
MN 12 _____________________________ WI21 ______________________________
I further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales
or Use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added
tax billing. This certificate shall be a part of each order which we may hereafter give to you, unless otherwise specified, and shall be
valid until canceled by us in writing or revoked by the city or state.
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
Authorized Signature: _____________________________________________________ (Owner, Partner or Corporate Officer)
Title: _____________________________________________________
Date: _____________________________________________________
PCS Wireless – Corporate
11 Vreeland Rd
Florham Park, NJ 07932
(973) 805-7400
www.pcsww.com
INDIVIDUAL PERSONAL GUARANTY
Date: ______/_______/________
I, ___________________________________, (Individual Guarantor) residing at _________________________ (home
address) for and inconsideration of PCS Wireless LLC (“PCS”) providing products and/ or services at my request,
receipt of which is hereby acknowledged, to__________________________ (Company Name) (hereinafter referred
to as “Company”) of which I am ____________________ (Title), hereby personally unconditionally guarantee to
PSC, its successors and assigns, payment of any obligations of the Company and I hereby agree to jointly and
severally bind myself to pay PCS on demand any sum which may become due to PCS by the Company. It is
understood that this guaranty shall be continuing in nature and revocable only upon formal written consent
by the CFO of PCS. Such revocation shall not apply to existing indebtedness but only on obligations arising
subsequent thereto. In the event an action is commenced to enforce my obligations under this Personal
Guaranty, I hereby agree to indemnify PCS for all attorney fees, court fees, and all other associated expenses.
I have read this Personal Guaranty and understand the contents thereof.
Signature: ______________________ SSN: ________________________
Witness: ______________________ Address: ________________________