|
Here's the info on the Epoch form:
-=-=-=-
In consideration of Paycom Billing Services Inc's ("Paycom") aiding in registering my company, or if applicable myself, as a sponsored high risk merchant under Visa regulations:
I represent and warrant that:
The business being registered has a permanent establishment in the United States through which economic activity is completed;
The business being registered has an address in the United States for correspondence and judicial process;
The business being registered holds a valid business license in the United States; and
The business being registered pays applicable taxes relating to the sales processed through Paycom in the United States.
I request that you register my business at the following address, and represent and warrant that the following information is true and correct.
Master Code :
Official Company Name :
Billing Descriptor (to appear on credit card statement, join form and prominently displayed on all websites) :
Example: PAYCOM.NET *XXXXXX CALL 800 893-8871
Where XXXXXX is your descriptor.
--------------------------------------------------------------------------------
Business Information
--------------------------------------------------------------------------------
Business Tax ID :
Business Street :
Business City :
Business State :
Business Zip :
Business Country :
--------------------------------------------------------------------------------
Principal Information
--------------------------------------------------------------------------------
NOTE: You only need to list one principal of the company.
Principal's First Name :
Principal's Last Name :
--------------------------------------------------------------------------------
Driver's License Number:
Driver's License State:
--OR:
Passport Number:
Passport Country:
--------------------------------------------------------------------------------
Principal's Street Address :
Principal's City :
Principal's State :
Principal's Zip :
Principal's Country :
Please list all other processors you will be using after Nov. 1, 2002 :
IBill
CCBill
Website Billing
Jettis
Other:
I understand that Paycom, its merchant bank(s) and Visa will all rely on the representations and warranties contained on this form, and I agree to indemnify Paycom, its officers, directors, shareholders, affiliated entities and persons, employees, agents, representatives and attorneys for any liability it may incur, including attorney's fees, as a result of any misrepresentation I make on this form.
I agree that Paycom may deduct $750 from my regular payments for the initial annual registration fee, and that thereafter it may deduct $325 from my regular payments for the subsequent annual registration fees. I understand that parties other than Paycom set the sponsored high risk merchant registration costs, and that Paycom may amend the registration fee if those other parties change the sponsored high risk merchant registration costs.
-=-=-=-
Greetings,
Art
|