MERCHANT  RECEIPT

 

APPLICATION FEE

(Non-Refundable)                                $__-0-__

 

 

LINK POINT or ECLIPSE  LEASE TERMS -

Equipment/Software __48__ months

 

LEASE PAYMENT*                     $_29.90_

 

 

*All leases subject to taxes, insurance and  approval by a leasing company. Equipment sales are the responsibility of Agent/Sales representative and not Cardservice International.  

 

 

 

 

PURCHASE AMOUNT                          $_-0-___

(Tax Included)

 

TOTAL  COLLECTED                           $_29.90_

 

 

METHOD OF PAYMENT: Visa/MC/Amex

 

CREDIT CARD NUMBER___________________

 

EXPIRATION DATE ______/________

 

 

                                                            

 

 

 

 

SERVICES

 

 

MONTHLY MINIMUM                       $15.00

 

 

DISCOUNT RATE ( Qualified)            1.69%

(Mid-qualified +0.95% )

( Non-qualified +1.95%)

 

 

 

 

TRANSACTION FEE                     $0.25

 

 

 

 

ADDRESS VERIFICATION  FEE                      

                                                                 $0.05

                                                            

 

 

MONTHLY CUSTOMER

SERVICE FEE                                        $10.00

 

               

 

DEBIT CARD TRANSACTIONS:        $_0.25_

Plus Debit Network Processing Fees

 

CardService Merchant Club                  $ 15.00

* All lease options are through an independent leasing company (Integrated Leasing). The leasing company will review the signer's credit and is subject to a separate approval process. Also, all equipment purchase options are the responsibility of the Agent (Merchant Account Solutions Inc / Cardservice Texas) not Cardservice International.

 

___________________________________________

Company Name

 

X__________________________________________        __C. Taylor___________________

Merchant Signature                                      Date                         Account Representative Signature

                                                                                                 CardService International
                                                                                                 450 N. Sam Houston Pkwy., Ste.273
                                                                                                 Houston, TX. 77060