The Payment Authorization Agreement is a new consolidated template that combines the ACH CC Auth Form and TK Finance Agreement into a single form.
This form will can be used for:
- Purchase of products in full in a single transaction.
- Purchase of products under a monthly payment plan.
Here's how to fill out each field:
PAGE 1 - BUSINESS AND BILLING INFORMATION
Business Legal Name | Referred to as the “IRS Name”. This is the name they file their taxes under, which id often different from the DBA. |
DBA Name | Referred to as “Doing Business As”. This is the name of the business that is visible to the customers (storefront, window, and/or door signages). |
Business Address | Street address where the business is located. |
City | City where the business is located. |
State | State where the business is located. |
Zip | ZIP code of the business location. |
Billing Address | Indicate the billing address of the business if different from the business address. Otherwise, leave blank. This information is important to obtain if the merchant wishes to pay by credit card. Credit card billing addresses can be associated with the business address, legal address, or card signor's personal address. |
City | City associated with the billing address |
State | State associated with the billing address |
Zip | Zip code associated with the billing address |
Phone | Contact number of the business. |
Email address of the business. |
PAYMENT AUTHORIZATION
Full Name | Owner's full name. |
Business Legal Name | Referred to as the “IRS Name”. This is the name they file their taxes under, which is often different from the DBA. |
One Time Charge (Amount) | For payments that will be collected in full within a single transaction, fill out this section with the amount due. Otherwise, leave blank. |
Date | Date of the charge. |
Pay Over-Time Billing (Amount) | For purchases that will be broken into a monthly payment plan, fill out this first line with the amount they will pay each month. Otherwise, leave blank. |
Date | Day of the month the monthly payment will be collected. |
Amount | Total amount that needs to be collected. |
PAYMENT METHOD
Make sure to check off the correct option (Bank Account Information/Credit Card Information).
BANK ACCOUNT INFORMATION | |
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Account Type |
If the merchant will pay via ACH, check off that apply. By default, Checking, unless otherwise indicated. |
Routing Number | By default, the ABA number on file, unless otherwise indicated. |
Account Number | By default, the DDA on file, unless otherwise indicated. |
CREDIT CARD INFORMATION | |
---|---|
Credit Card Type | If the merchant will pay via CC, this is left blank for the merchant to fill out. |
Card Number | Merchant's card number. |
Expiration Date | Merchant's card expiration date. |
CVV | Merchant's card CVV. |
Please note that there is a signature field together with the name and the date at the bottom of the page.
PAGE 2 - EXHIBIT A: HARDWARE ASSIGNMENT AGREEMENT
EQUIPMENT DETAILS
Equipment & Quantities |
Specific make and model of the devices to be purchased. List down all equipment in the space provided. For two or more, indicate the number of devices needed. (e.g. (2) Dejavoo QD4) |
Total Price | Total amount of the equipment above. |
PAYMENT TERMS
Term Length | Number of installments if payment is made through a specific plan. |
Monthly Payment | Total Price divided by the term length. |
SIGNATURES AND ACCEPTANCE
By default, the Personal Guarantor and Authorized Representative section will be the same.
Signature | Owner/Authorized Signer's signature. |
Printed Name | Owner/Authorized Signer's full name. |
Title | Owner/Authorized Signer's official designation. |
Date | Date the document is signed. |
Disregard Turnkey Processing, LLC Approval section and leave blank.