The following form is used to collect preliminary information related to the Sales & Merchant Profiles sections contained on the coreCLEAR merchant application to be completed via eSignature.

This is not an official document, nor does it serve as a substitute for the coreCLEAR merchant application.

Sales Profile
The following section requests the amounts ($) related to card payment sales. Values can be projections or estimates, and do not have to be exact figures.

Merchant Profile
Please designate the percentage (%) amounts based upon the following card acceptance methods.

• Total Must Equal 100%

Pricing Model
Which rate structure will you be using?

Payment Terminals
If conducting retail sales, please specify which payment terminal(s) is/are to be used. If not requiring a payment terminal, please select [No Terminal Required]

• Purchase of CLEAR 8500 occurs on website at https://coreclear.com/device-8500
• Purchase of CLEAR 6200 occurs on website at https://coreclear.com/device-6200
• Purchase of Dejavoo Z8 & Z1 occur via electronic invoicing