Factor4 Merchant Set Up Form

Per LocationPricing/Monthly
Merchant Information
Legal Name of Merchant*
DBA Name or Trade Name*
Company Name*
Number of Locations*
Company Address*
City*
State*
Zip*
Company Phone*
EXT

Area CodePhone Number
Website*
Per Location Pricing/Monthly
# Of Cards
Pricing
Card and Starter Kit Info
Contact Information
Primary Contact*
Phone*
Email*
example@example.com
Secondary Contact
Phone
Email
example@example.com
Equipment

Standalone (Gift Only) orIntegrate with Credit Card
IP or Dial
Terminal Type/POS System*
Number of Terminals*
Credit Card Processor
Gift and/or Loyalty

Gift OnlyLoyalty OnlyGift & Loyalty
Loyalty Program Options* - Choose the program description that best describes what youwant to offer to cardholders.

A card holder can accumulate points based on dollars spent. Once they reach a certain level they are eligible to redeem those points.
A card holder is rewarded when they reach a certain level. The threshold, reward and point to dollar ratio varies per merchant.

Points for PrizeThresholdPercentage Cash BackPunch Card
A cardholder is given a percentage of their purchases as a cash back reward onto their card. The merchant determines the percentage.

A card holder is given a “punch” or credit for each qualifying purchase. When they reach a certain level the cardholder receives a free item. The merchant determines the item and level.
Pursuant to the Merchant Agreement for Transaction Services it is necessary for Merchant to provide Factor4 with its banking information to facilitate billing and payments. It is the Merchant’s obligation to inform Factor4 of any changes to its banking details and accounts. Factor4 will not be liable for any funds incorrectly transferred as a result of a change in banking information or errors that directly resulted from information provided by Merchant.
Merchant authorizes Factor4 to debit from the Merchant’s b a n k a c count all monthly payments and other amounts owed to Factor4 related to the Tr ansaction Services. This authorization shall remain in effect after termination of the Agreement and for as long as Merchant owes any amounts to Factor4. Merchant agrees that Factor4 will not be liable for any loss or damage incurred as a result of anything done or not done pursuant to this authorization. If the account is transferred to another branch or the account is closed and an account is opened at another bank this authorization shall have the same force and affect as if it originally was directed to that branch or bank.
Electronic Funds Transfer Information
Bank Name*
Branch*
City*
State*
9-Digit Bank Routing Number*
Account Number*
The undersigned Guarantors acknowledge and agree to be bound by all the terms and conditions of this Agreement and unconditionally guarantee the performance of this Agreement. By signing below, Merchant (I) represents that the information provided by Merchant in this Agreement is true, complete and not misleading; (II) acknowledges that Merchant has read and understands this Agreement and Operating Procedures and agrees to be bound by their terms; and (III) authorizes Gift Loyalty Services and its agents to credit and debit the Designated Automatic Funds Transfer Account in accordance with this Agreement.
Principal (Signature Required)*

Clear
Title*
Print Name*
Date*

MonthDayYear
Date
Voided Check

Cancelof
For full Factor4 Merchant Agreement visit: www.factor4gift.com/merchant-agreement. Attach voided check from bank account.
Email
example@example.com
Should be Empty:

Per LocationPricing/Monthly

Merchant Information

Per Location Pricing/Monthly

Contact Information

Electronic Funds Transfer Information