DermPRO Online Store and Merchant Processing Account Access
This form authorizes login access to your DermPRO Online Store Admin Panel and/or your Merchant Processing Account(CardConnect/Bluepay). Please note that handling of the merchant processing account, processing refunds, etc. is typically not covered under DermPRO's support plan except in the case of an emergency. There are three types of access: 1) Online Store Backend Admin Panel access is required to process orders from the store, access customer information, manage in-office gift card redemption, etc. 2) Merchant Processing Account login access is required to see why a credit card was declined or to process refunds. 3) Receive copies of all BluePay transaction email notifications. This includes all failed and successful transactions, refunds, and daily settlements, and these are an important tool for helping patients who may be having trouble checking out, as well as for identifying potential fraud threats.
What is the name of your business?
Please fill in the following details for anyone who requires login access. EACH PERSON MUST HAVE A UNIQUE EMAIL ADDRESS.
First and Last Name
Professional Designation?
Email Address *UNIQUE*
Give Access to login to Store Backend Admin Panel?
Give Access to login to Merchant Processing Account (Bluepay)?
Receive copies of all BluePay transaction email notifications?
Primary Order Processor
MD
DO
PA-C
OTHER
Yes
No
Yes
No
Yes
No
Additional Order Processor #1
MD
DO
PA-C
OTHER
Yes
No
Yes
No
Yes
No
Additional Order Processor #2
MD
DO
PA-C
OTHER
Yes
No
Yes
No
Yes
No
Additional Order Processor #3
MD
DO
PA-C
OTHER
Yes
No
Yes
No
Yes
No
Additional Order Processor #4
MD
DO
PA-C
OTHER
Yes
No
Yes
No
Yes
No
Additional Order Processor #5
MD
DO
PA-C
OTHER
Yes
No
Yes
No
Yes
No
For the Online Store Admin Panel, should the above people have full access to all sections? (If you select no, a new question will appear to ask which access options are approved.)
Yes
No
Which Online Store access options should we provide to the above employee? *We recommend full access.
ORDER MANAGEMENT - Allow user to see and process orders
SUBSCRIPTIONS - Allow user to see and manage subscriptions
CUSTOMERS -Allow user to see and manage customer information
REPORTING - Grant user access to see and run reports
REVIEWS - Allow user to see and approve reviews
GIFT CARDS - Allow user to manually close an open batch.
SUPPORT TICKETING - Grant user access to Support Tickets
Please review all of your information above. Are the names, email addresses, titles and access levels for each person correct?
*
Yes, I certify that all information above is correct and complete.
Is there anything else you would like for us to assist you with regarding this set up?
Name of the Person Completing this Form
First Name
Last Name
SIGNATURE OF AUTHORIZED PERSON IMPORTANT - THIS SIGNATURE MUST BELONG TO THE PERSON WHO APPLIED FOR YOUR MERCHANT ACCOUNT OR WHO IS ALREADY NAMED ON YOUR MERCHANT ACCOUNT. I authorize the above access and further understand that if I don’t give full access to at least one primary person other than myself, then the primary contact associated with our BluePay account (usually the person who applied for the merchant account) will be responsible for all BluePay interactions, including transaction look-ups, voids, refunds, etc.
*
Submit
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