Card One International Application and Agreement

Merchant Processing Application and Agreement

Parties and Services

Location Information

*If your business is classified as High Risk and assigned (or is later assigned based upon your business activity) any of the following Merchant Category Codes (MCC): 5966, 5967, and 7841¹, then registration is required with Visa and/or Mastercard within 30 days from when your account becomes active. An Annual Registration Fee of $500 may apply for Visa and/or Mastercard (total registration fees could be $1,000.00). Failure to register could result in fines in excess of $10,000.00 for violating Visa and/or Mastercard regulations2. ¹Registration for MCC 7841 is only required for non-face-to-face adult content 2Information herein, including applicable MCCs, is subject to change

Corporate Information

(Also for Headquarter’s Info. and if different then DBA)
Same as DBA Name

Corporate Contact Information

Same as Location:
Organization Type


Failure to provide accurate information may result in a withholding of Client funding per IRS regulations (See Part IV, A.4. of your Program Guide for further information.)
(as it appears on your income tax return)
Federal Tax ID #
(as it appears on your income tax return)
I certify that I am a foreign entity/nonresident alien.
(If checked, please attach IRS Form W-8.)

Sales Information

Visa /Mastercard Volume Percent:
Swiped %
Keyed %
Discover® - PayPal Volume Percent:
Swiped %
Keyed %
American Express OptBlue® Volume Percent:
Swiped %
Keyed %
Bankcard Sales %:
Hand Keyed %
Face to Face %
Mail /Phone %
Internet %
Tradeshow %


Provide the following information for each individual who owns, directly or indirectly, 25% or more of the equity interest of your business
Home Address

Banking Information

Total Sales

Bankcard Sales

Order Delivery

Order Delivery Day %
0-7 Days %
8-14 Days %
15-30 Days %
30+ Days %
Mastercard/Visa /Discover® - PayPal/American Express OptBlue® Sales deposited:
Mode of Advertising




Use third party to store, process, transmit Cardholder data?

Trade References


Mail Card Statements / Documents

Statement Recap Information:
Statement Type
On Your Business Account Checking Statement Rollup

Site Survey

Visit Performed
Seasonal Merchant
Fire Safety Act
Advertising Name Displayed:
Proper License Displayed

Return Policy

Return Policy

Previous Processor


✓MC/Visa /Discover Network - PayPal Full Processing (Discover Network systems and rules will process and govern JCB, Diners Club International, and BC Card Transactions
Voyager Fleet or
MC Fleet
Wright Express or
*Tax exempt Voyager Cards accepted
WEX Full Acquiring
American Express OptBlue®
Amex Pass Through (existing) SE #
(MCC 4722)
Check one for Pass Through:
Debit Pkg.
Non Lic. JCB (EDC) Existing SE #:

Describe Equipment Details

Describe Equipment Details
Customer Owned, Lease, Purchase (select one)
Equipment Type
Retail, Restaurant, MOTO/Internet Lodging, Supermarket, Car Rental, Quick Service Restaurant, Petr
Model Code and Name
Clover Unit Price w/o Tax
For Customer-Owned Equipment Track/Version/Serial #
*Clover Equipment Purchase Only:. This is for information purposes only. Please refer to your equipment purchase agreement with TASQ Technology, Inc. or your equipment lease agreement with First Data Global Leasing for information and pricing and fees for your equipment or hardware. You are not purchasing or leasing equipment from Processor and you acknowledge and agree that Processor will have no obligation or liability relating to such purchase or lease of equipment. Your purchase or lease of equipment is subject to separate terms and conditions between you and the equipment seller or lessor


Any Special Instructions must be included on About Merchant’s Business Page. (receive training via phone, dial 1-800-558-7101 Opt. #1, M-F 8AM - 10PM EST & Sat. 10AM - 7PM EST) (Check Training via phone 1-800-366-1054 7AM - 6:30PM CT)
Imprinter Purchase
Wireless Provider
Check One
NOTE: ***Requires separate agreement between VSAT Provider prior to implementation of this telecommunications protocol.

FDGL Leasing

LEASE COMPANY: (04) First Data Global Leasing
Annual Tax Handling Fee
(w/o taxes, late fees, or other charges that may apply. See Lease Agreement for details. This is a NON-CANCELABLE lease for the full term indicated.)

Option to purchase: If you wish to buyout the equipment, please contact 1-877-257-2094 to obtain the cost.