Company Representations and Certifications. By signing below, the applicant company (“Company”) and its representative(s) represent and warrant to Elavon, Inc. (“Elavon” or “Member” as applicable), with offices at 7300 Chapman Highway,
Knoxville, TN 37920 (collectively, “we” or “us”) that (i) all information provided. In this company application (“Company Application”) is true and complete and properly reflects the business, financial condition, and principal partners, owners, or officers of Company; and (ii) the persons signing this Company Application are duly authorized to bind Company to all provisions of this Company Application and the Agreement. Further, by signing below, Company and its representative(s) agree that Company is subject to the terms and conditions set forth in the Terms of Service (“TOS”), including when leasing equipment, and has had an opportunity to review such terms. The TOS contains a mandatory and binding arbitration provision that affects Company’s legal rights and should be reviewed prior to signing this document*.The signature by an authorized representative of Company on the Company Application, or the transmission of a Transaction Receipt or other evidence of a Transaction to us, shall be the Company’s acceptance of and agreement to the terms and conditions contained in the Agreement including, without limitation, this Company Application, the TOS and the Operating Guide incorporated herein by this reference and located at our website at https://www.merchantconnect.com/CWRWeb/pdf/TOS_ENG.pdf and https://www.merchantconnect.com/CWRWeb/pdf/MOG_Eng.pdf, respectively. If Company does not have access to view the TOS or Operating Guide at our website please contact our customer service center to obtain a copy and review prior to signing this document. Notwithstanding any non-receipt of the TOS or Operating Guide, Company agrees to comply
with the Agreement, and all applicable laws, rules, and regulations including the rules and regulations of the Payment Networks, and understands that failure to comply will result in termination of processing services. Capitalized terms shall, unless otherwise defined in this Company Application, have the same meaning ascribed to them in the TOS and Operating
Guide.IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. This means we will ask for certain information and identifying documents to allow us to identify you. Company and its representative(s) authorize us prior to our acceptance of this Company Application and from time to time thereafter, to investigate the individual and business history and background of Company, each such representative and any other officers, partners, proprietors, and/or owners of Company, and to obtain credit reports or other background investigation reports on each of them that we consider necessary to review
the acceptance and continuation of this Company Application. Company also authorizes any person or credit reporting agency to compile information to answer those credit inquiries and to
furnish that information to us.
This Company Application may be signed in one or more counterparts, each of which shall
constitute an original and all of which, taken together, shall constitute one and the same
Company Application. Delivery of executed counterparts of this Company Application may be
accomplished by a facsimile transmission, and a signed facsimile or copy of this Company
Application shall constitute a signed original.
A PIN Debit Enablement Service Fee will be collected for any Interchange and Assessment
savings generated through PIN Debit routing on your monthly PIN Debit transactions for
Interchange Plus customers only. This monthly fee will be calculated from your actual PIN Debit
transaction volume and will be a percentage of your overall PIN Debit cost savings. The PIN
Debit Enablement Service Fee collected and the Interchange and Assessment savings will be
reflected on your monthly statement.
Company understands that an authorization code is not a guarantee of acceptance or payment of a
Transaction. Receipt of an authorization code does not mean that company will not receive a Chargeback
for that Transaction.
All companies must comply with the requirements of the Payment Card Industry Data Security Standards
(“PCI DSS”). Elavon requires Level 4 companies (determined based on Transaction volume) to validate
PCI DSS compliance on an annual basis, with initial validation to occur no later than ninety (90) days after
account approval. Any company that has not validated PCI DSS compliance within ninety (90) days of
account approval, or in subsequent years on or before the anniversary date of account approval, will be
charged a monthly non-compliance fee of $74.99 until Elavon is provided with validation of PCI DSS
compliance. Company may be eligible for Data Breach Financial Assistance Coverage following account
approval and PCI DSS compliance validation. See the PCI Compliance Program Overview for assistance
details and conditions. Under penalties of perjury, Company certifies that:
- The number shown on this Company Application is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
- I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
- I am a U.S. citizen or other U.S. person.**
- The FATCA code(s) entered on this form (if any) indicating I am exempt from FATCA reporting is correct.
American Express Acceptance Program (Acceptance Program). If Company has elected to accept American Express® Transactions (as indicated in the Card Acceptance section of this Company Application), in addition to all other terms of this Agreement, Company agrees to the Acceptance Program terms of the TOS. By signing below or by accepting a Transaction initiated with an American Express® Payment Device, Company expressly authorizes Elavon to submit American Express® Transactions to, and to receive settlement funds from, American Express on Company’s behalf. Company further authorizes Elavon to provide Company’s contact information to American Express, and Company agrees that American Express may use and share such contact information for its business purposes and as permitted by applicable Laws, including to communicate with Company regarding products, services, and resources available to Company’s business. American Express’s use of the email address and mobile phone number provided above is subject to the consent to such use as indicated in Section 1 of this Company Application. Consent to American Express’s use of contact information for such communications may be withdrawn at any time by contacting our customer service center. Even if consent is withdrawn, Company may still receive messages related to important information about Company’s account from American Express. Company or Elavon may terminate Company’s acceptance of American Express® Payment Devices at any time, with or without cause, without affecting Company’s rights and obligations pursuant to the remainder of this Agreement. Company acknowledges that, if at any time Company is no longer qualified to participate in the Acceptance Program, Company may be enrolled in the standard American Express® card acceptance program, which may have different terms and conditions than the Acceptance Program, and Company’s acceptance of American Express® Payment Devices pursuant to this Agreement will be terminated. Company acknowledges that American Express is an intended third-party beneficiary of this Agreement, solely with respect to the terms and conditions applicable to Company’s acceptance of American Express® Payment Devices, and that American Express has the right to enforce such terms and conditions directly against Company.