Merchant Information
Legal Name of Merchant
DBA Name or Trade Name
*
Company Name
Number of Locations
*
Company Address
*
City
*
State
*
Zip
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Website
Per Location Pricing/Monthly
Gift - $29 | Gift+ - $35 | Loyalty - $29 | Cardless Loyalty - $60Unlimited Transactions and full reporting!
Cards/Starter Kit Pricing
# of Cards
Contact Information
Primary Contact:
*
Primary Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Contact Email
*
example@example.com
Secondary Contact
Secondary Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Contact Email
example@example.com
Terminal Type/POS Station
*
Number of Terminals
*
Credit Card Processor
Program Type
Gift Only
Loyalty Only
Type option 3
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Factor 4
Merchant Set-Up Form
The Gift & Loyalty Factor for Success
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 bank account all monthly payments and other amounts owed to Factor4 related to the Transaction 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 (1) 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)
*
Title
Print Name
*
Date
*
-
Month
-
Day
Year
Date
For full Factor4 Merchant Agreement visit: www.factor4gift.com/merchant-agreement. Attach voided check from bank account.
Voided Check
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