Fillable Merchant Enrolment Form

Fill Online, Printable, Fillable, Blank Merchant Enrolment Form Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Merchant Enrolment Form

On average this form takes 31 minutes to complete

The Merchant Enrolment Form form is 6 pages long and contains:

  • 5 signatures
  • 16 check-boxes
  • 95 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Ver 6.0 07/18
Merchant Enrolment Form
Application Checklist:
Company Information
Questions about the application? Call 1-855-559-0909
Legal status:
Business name:
Legal company name:
Jurisdiction of incorporation or registration:
Please tell us what your business does:
What goods or services do you sell:
Do you supply merchandise or services that are provided to the customer at a later date?
(e.g. custom-built furniture, home remodelling, delivered goods):
Due to specific regulations applicable to the following
business types, please advise if your business does any
of the following (check all that apply):
Sells door-to-door or in-home
Page 1/6
Sells merchandise requiring installation
(e.g. hot tubs, shower systems, carpeting,
flooring, kitchens and bathrooms)
Signed Merchant Agreement Acknowledgment
Sole proprietorship Corporation Partnership
Signed and completed Business Pre-Authorized
Debit Agreement
Signed and completed Merchant Enrolment Form
Void cheque (issued by bank in business’ name)
Official document(s) showing corporate name and/or
operating name, if applicable (e.g. bank document(s),
government document(s), incorporation document(s),
city license, etc.)
(Continued on next page)
Yes No
Ver 6.0 07/18
Business start date (MM/DD/YYYY):
Date of birth (MM/DD/YYYY):
Date of birth (MM/DD/YYYY):
SIN (Optional):
SIN (Optional):
Has store front: Yes No
/
/
/
/
/
/
M
M
M
D
D
D
Y
Y
Y
M
M
M
D
D
D
Y
Y
Y
Head oce address:
Home address:
Home address:
Phone number:
Primary contact name: Primary contact title:
Phone number:
Phone number:
Personal credit check consent
Personal credit check consent
By providing the information requested below, you authorize and consent to the receipt and exchange of any credit information pertaining
to you as an individual, including the collection and exchange of credit information, a credit check, and other information concerning you
personally from any credit bureau or any other party.
By providing the information requested below, you authorize and consent to the receipt and exchange of any credit information pertaining
to you as an individual, including the collection and exchange of credit information, a credit check, and other information concerning you
personally from any credit bureau or any other party.
Ownership percentage:
Ownership percentage:
Name: (1)
Name: (2)
Email:
Email:
Email:
Number of locations:
Annual sales $:
Total number of employees:
Average ticket $:
Website:
Alternative phone number:
Number & Street Name
Number & Street Name
Number & Street Name
City
City
City
Province
Province
Province
Postal Code
Postal Code
%
%
Postal Code
Owner(s) Information
Merchant Enrolment Form Continued
(Continued on next page) Page 2/6
Ver 6.0 07/18
By signing this application you are confirming that:
Email consent:
(1) Authorized signature
Print name: Print name:
Print title: Print title:
Date (MM/DD/YYYY): Date (MM/DD/YYYY):
/ // /
(2) Authorized signature
1. You have read this Application and the declarations set out herein and that that applicant understands and agrees to be
bound by the terms and conditions contained in this Application, as well as the terms and conditions
contained in the Merchant Agreement.
2. The individual(s) who have signed this Application and the Merchant Agreement are duly authorized to sign the applica-
tion and Merchant Agreement on behalf of the applicant and no consent or approval is required from any other person.
3. The information provided in this Application is correct and not misleading, and the applicant has not withheld any rele-
vant information.
4. You, personally and on behalf of the applicant, authorize Flexiti Financial to use the information provided by you to
process this Application.
5. The applicant acknowledges that further information may be required to process this Application, including but not
limited to trade references, bank references and the applicant’s financial statements.
6. The applicant acknowledges that Flexiti Financial is under no obligation to approve or accept this Application.
7. The applicant will notify Flexiti Financial in advance of any changes to the information provided herein.
8. The applicant authorizes and consents to the receipt and exchange of any credit information pertaining to the business
by Flexiti Financial including the collection and exchange of credit information, a credit check and other financially relat-
ed information concerning the applicant from any credit bureaux or any other party.
9. You, personally and on behalf of the applicant, consent to the collection of personally identifying information for the
purposes of processing this Application and the use thereof in accordance with Flexiti Financial’s Privacy Policy which
can be found at www.flexitifinancial.com
I agree to receive commercial electronic messages (newsletters, promotional emails,
tech/app updates etc.) from Flexiti Financial. Consent may be withdrawn at any time.
Please refer to our privacy policy, found at www.flexitifinancial.com, or contact us for
more details.
Initial: (1)
(2)
Yes
Yes
Page 3/6
Merchant Enrolment Form Continued
click to sign
signature
click to edit
click to sign
signature
click to edit
Ver 6.0 07/18
Phone number:
Business Pre-Authorized
Debit (PAD) Agreement
Legal name of business:
Merchant (Account Holder) Information (Please print clearly) :
Bank Account Information :
Mailing address:
Branch address:
Number & Street Name
Number & Street Name
City
City
Province
Province
Postal Code
Postal Code
Deposit account #:
Financial institution name:
Branch transit #: Financial institution #:
Chequing account
Dated this day of 20
Authorized Signatory of Merchant (Account Holder) Authorized Signatory of Merchant (Account Holder)
Savings account
By signing this Business PAD agreement, you the
Merchant and Account Holder (“the Payor”) authorize
Flexiti Financial Inc. to draw upon the bank account
as indicated above for the reasons set out in the
Merchant Agreement between the Payor and
Payee. The timing and amount of each debit will be
determined in accordance with the Merchant
Agreement. You certify that all information contained
in this form is accurate and agree to promptly inform
the Payee, in writing, of any change in the information
associated with the bank account provided in this
immediately. A pre-printed personalized void cheque
must be included with this authorization.
Receipt of a Merchant Settlement Report (“the
Report”) issued by the Payee serves as notice of
the date of the debit and the amount to be debited
from your account. Such amounts will be variable
depending on the Payor’s activities during the period
covered by the Report. The Report shall also be the
Payor’s sole advance notification of any PAD on the
account. You waive the right to be pre-notified of a
change if the amount debited from your account is
dierent than the amount specified on the Merchant
Settlement Report, however, only amounts permitted
to be charged to the merchant under the Merchant
Agreement will ever be debited from the Payor’s
account. Both the Payor and the Payee expressly
waives any pre-notification period that may be
provided in the rules.
This Authorization may be cancelled at any time upon
written notice of thirty (30) days by you to the Payee.
You may obtain a sample cancellation form, or further
information on your right to cancel a PAD Agreement, at
your financial institution or by visiting www.cdnpay.ca
You have certain recourse rights if any debit does not
comply with this agreement. For example, you have
the right to receive reimbursement for any debit
that is not authorized or is not consistent with this
PAD agreement. To obtain more information on your
recourse rights, contact your financial institution or
visit www.cdnpay.ca
Revocation of this Authorization does not terminate
any contract for goods or services that exists between
you and the Payee. This Authorization applies only
to the method of payment and does not otherwise
have any bearing on the contract for goods or services
exchanged.
You understand and agree to this PAD arrangement
and to the disclosure of any confidential information
to any third parties as may be required to process the
PAD in accordance with the CPA Rules.
For inquiries, concerns about the Report, to obtain
information or to seek recourse with respect to any
PAD issued by the Payee, the Payor may contact the
Payee by calling 416-583-1860 or e-mailing
sales@flexitifinancial.com
Print name: Print name:
Page 4/6
Each account holder of a joint account must sign below.
click to sign
signature
click to edit
click to sign
signature
click to edit
Ver 6.0 07/18
Merchant Agreement –
Summary of Key Terms
The information contained in this summary of key terms is not intended to replace or act as a substitute to the actual Merchant Agreement (“Agreement”) or the terms and
conditions contained therein. The Merchant confirms having read and understood the entire Agreement before signing or electronically accepting the Agreement. All capitalized
terms contained in this summary have the same meaning as set out in the Agreement.
Contract Term and
Early Termination
• 3 years
• This Agreement may be terminated before the end of the term by either party upon written notice or by Flexiti in accordance with
section 11 (b) of the Agreement
Cost of Tablet and
Repair or Replacement
(applicable to tablet
users only)
• $19.99/month if wireless data plan is provided by Merchant and $29.99/month (plus any charges for data overages) if wireless data plan is
provided by Flexiti.
• Merchant is responsible for all costs related to the replacement of the tablet, in the event of loss or theft, misuse, excessive wear and tear or
violation of the manufacturer’s warranty.
• Flexiti will promptly provide Merchant with a replacement tablet following loss, theft or damage
Training and
Operating Procedures
• Merchant and Merchant’s Personnel will adhere to all account opening and operating procedures as determined by Flexiti
• Merchant is responsible for the security of the tablet and for any unauthorized use of the tablet or Merchant App by Merchant and
Merchant’s Personnel
• Merchant is responsible for Merchant Personnel’s training, access and use of the Merchant App and is liable for any unauthorized use of the
Merchant App or breach of any Merchant Procedures
• Merchant will ensure all Applications are completed by an Applicant in accordance with the Merchant Procedures
Application Process
and Identification of
Customer
• Merchant will ensure Customer is presented with and given an opportunity to review Flexiti’s Cardholder Agreement before completing an
Application.
• Merchant will ensure Customer provides a valid, accessible email address at the time the Customer submits an Application
• Merchant will act as Flexiti’s agent for the purpose of confirming the identity of the Customer and that they will not process an Application
where identification of the Customer is unavailable or expired, or where the photograph and/or signature on the identification is not similar
in appearance to the Customer’s appearance and/or signature at the point of sale
Merchant Discount
Rate
• A Merchant Discount Rate (“MDR”) may apply to certain Credit Transactions. The MDR will be determined by Flexiti from time to time, and is
subject to change
Payment to Merchant
• Flexiti will credit Merchant’s account for the amount of the Credit Transaction after each transaction, less the applicable MDR
• Flexiti may withhold amounts otherwise payable to the Merchant necessary to cover any MDRs, Chargebacks, Dispute Resolution Fees,
Tablet Subscription Fees and Charges or any other amounts that may be payable by Merchant to Flexiti
• Flexiti may set o against the amount withheld monies owed to Flexiti by Merchant on account of MDRs, Chargebacks, Dispute Resolution
Fees, Tablet Subscription Fees and Charges or any other amounts that may be payable by Merchant to Flexiti
Returns and
Adjustments
• Upon return of Goods, the termination or cancellation of any Services, or any price adjustment on any Goods and/or Services, the Merchant will
not provide the Customer a cash refund, but will generate a credit to the Customer to be applied immediately to his or her Flexiti Account
• Merchant will be credited MDR paid for Credit Transactions where a return or cancellation is made within thirty (3o) days of the Credit
Transaction
• Merchant will be credited the portion of the MDR payable on the dierence between the original price and the adjusted price of the Goods
or Services for any price adjustment made within thirty (30) days of the Credit Transaction
• The Merchant will receive no refund of the MDR in the event that the Merchant (a) accepts any Goods for return; (b) permits the termination
or cancellation of any Services; or (c) allows any price adjustment on any Goods and/or Services after the expiration of thirty (30) days from
the date the Credit Transaction for the Goods or Services was completed
Chargebacks
• Flexiti may chargeback to Merchant any transaction which Flexiti has taken reasonable steps to collect upon and reasonably deems to be
uncollectible as a result of Unresolved Cardholder Disputes, Improper Sales Floor Procedures or a breach of Merchant’s representations,
warranties or covenants
• Please see section 8 of the Agreement for the definition of ‘Unresolved Cardholder Disputes’ and ‘Improper Sales Floor Procedures’
Cardholder
Complaints and
Disputes
• Merchant must handle all complaints and disputes by Cardholders relating to purchases from Merchant, except any complaints or disputes
relating to a Cardholder’s statement of account or Flexiti’s method of billing
• In the event that Flexiti is required to investigate or handle a Cardholder complaint or dispute other than in relation to a Cardholder’s statement of
account or billing method wherein Flexiti determines in its discretion that Merchant is at fault, Merchant will reimburse Flexiti the sum of $25.00
per dispute
Set-O
• Flexiti will set-o any MDRs, Chargebacks, Dispute Resolution Fees, Tablet Subscription Fees, Charges and any other sums owing to Flexiti
from money due by Flexiti to the Merchant
• Merchant will immediately pay any amount which cannot be set o
• Payment will be made through direct debit of Merchant’s bank account
• In the event Flexiti is unable to directly debit any payment required from the Merchant’s bank account, and Merchant fails to immediately make
any payment required, Flexiti will have the right to pursue any remedies to obtain such amounts, or to set-o any amounts owed to Flexiti
• Flexiti, in its discretion, may require a Merchant to provide a security deposit for payment of MDRs, Chargebacks, Dispute Resolution Fees,
Tablet Subscription Fees or Charges and any other sums payable to Flexiti
Ownership of
Credit Card Accounts
• Merchant agrees and understands that Flexiti will establish, approve and own all Credit Card Accounts, and that Flexiti is the party extending
the credit on the Credit Card Accounts
Payments from
Cardholders
• Merchant agrees that it will not make an attempt to make any collections, or receive any payments, on any Credit Card Account or Sales Slip
submitted to Flexiti
Page 5/6
Ver 6.0 07/18
Merchant Agreement – Summary of Key Terms
Flexiti Materials • Merchant may display Flexiti’s signs, decals or other identification of Flexiti’s Program at Merchant’s place of business and website during the
term of this Agreement
• Flexiti grants Merchant a limited non-exclusive, royalty-free, non-transferable licence to use Flexiti’s Marks for the term of the Agreement
Review of Customer
Materials Produced by
Merchant
• Flexiti must review and approve any promotional materials produced by Merchant in connection with this Agreement
• Flexiti will use commercially reasonable eorts to review Customer Materials in a timely manner
Goods and Services
• Flexiti is not responsible for ensuring the quality of the Goods/Services
• If Merchant uses agents or subcontractor to sell or install Goods/Services, it will use only reputable agents and subcontractors, and will
ensure agents and subcontractors meet all Warranties
Merchant’s
Representations,
Warranties and
Covenants
• Merchant warrants the validity of transactions and enforceability of Sales Slips
• Merchant will comply with Applicable Laws and all Flexiti instructions and procedures
• Merchant will resolve Unresolved Cardholder Disputes
• Merchant will ensure that Personnel are properly licensed to sell, install and/or service the Goods/Services
• Merchant will advise Flexiti if it is insolvent, intends to cease doing business, or changes the nature of its business
Limitation of Liability
• Flexiti’s aggregate liability to Merchant will not exceed the lesser of (i) the amount which Flexiti paid Merchant for the applicable Sales Slip in
connection with the transaction which precipitated the claim; and (ii) the total amount of Merchant fees paid by the Merchant to Flexiti in the
six (6) months immediately preceding the date the claim arose
• Flexiti is not liable to Merchant for any indirect, special, incidental or consequential damages, whether based on breach of contract, tort
(including negligence) or otherwise
Indemnification • Merchant will indemnify Flexiti against any claims, losses, damages, expenses and liabilities incurred or suered by any of them
• arising from or relating to:
• A breach of any term, condition, covenant, warranty or other provision of this Agreement by the Merchant or its Personnel
• Any alleged violation by Merchant of any Applicable Law, including violations caused by Merchant’s incomplete compliance or
noncompliance with Flexiti’s written instructions and/or procedures
• Any deficiency in Goods/Services, however such deficiency is caused or may arise
• The Cardholder rescinding or exercising any right to cancel a transaction
• Any personal or bodily injury or property damage alleged to be caused by the sale of the Goods and/or Services by Merchant
Confidentiality • Merchant will not use or disclose any of Flexiti’s Confidential Information, which includes the terms of the Agreement, Flexiti’s MDR rates,
Flexiti training materials and Merchant Procedures except in accordance with the terms of the Agreement
Amendments
to Agreement
• Flexiti may vary the Agreement at any time by giving the Merchant written notice of such changes
Electronic Agreement
and Communication
• Merchant consents to using electronic signatures to execute the Agreement and receiving from Flexiti all documents, required disclosures,
notices and statements, including any changes in terms, in electronic form (either posted to Flexiti’s website or inan e-mail to the Merchant)
Please ensure you have read the entire Merchant Agreement
*
before proceeding.
You may view, save and print the Merchant Agreement by visiting:
www.exitifinancial.com/ma
Acknowledgement and Acceptance of Merchant Agreement
Each business owner must sign below.
You authorize and consent to the receipt and exchange of any credit information pertaining to you as an individual, including the collection and
exchange of credit information, a credit check and other information concerning you personally from any credit bureau or any other party.
Signature
Print or type Signatory’s name: Print or type Signatory’s title:
Print or type Merchant’s legal name
(and trade name if applicable):
Date (MM/DD/YYYY):
/ /
Page 6/6
* Version 6.0 07/18
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Merchant Enrolment Form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 15 June 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document