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:

  1. Purchase of products in full in a single transaction. 
  2. 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 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
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. 
The term will be 1 if this is a one-time payment
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.