Merchant Processing Applications and Merchant Account Documents
NOTE: All new merchant applications require a copy of a voided check OR a bank letter and a copy of the primary signer's drivers license. All new merchant applications must have wet signatures, unless our office is sending for electronic signatures (no iPad signatures, etc). All bank change requests require the wet signed form, a voided check or bank letter and a copy of the original signer's driver's license.
Click HERE! for Comparison of Processors- NEW as of 03/2026
APPLICATION DOCUMENTS
- Electronic Application Link for Agent or Merchant (TSYS/Global or FirstData/Fiserv) – NEW!!!
- Don’t forget to send in a copy of the merchant’s Drivers License and Voided Check
- Application Checklist
TSYS/GLOBAL
- Merchant Processing Application (TSYS/Global) – NEW 5/2026!
- Merchant Processing Application Highlighted (TSYS/Global) NEW 5/2026!
- Sample Merchant Processing Application ON CASH DISCOUNT (TSYS/Global)
- Sample Merchant Processing Application Rate Page FOR INTERCHANGE PLUS (TSYS/Global)
- Terms and Conditions (TSYS/Global) Make sure to match the version to the app.
FIRST DATA/CARD CONNECT/FISERV
- Merchant Processing Application (FirstData/Fiserv) – *includes prog guide from below
- *Merchant Processing Program Guide (FirstData/Fiserv)
- Sample Merchant Processing Application (FirstData/Fiserv)
PCS 4 FUEL
- AGENT Background Check – Required if you’re submitting your first PCS application.
- Merchant Processing Application (Fuel & Fleet) – *add prog guide below
- *Merchant Processing Program Guide (Fuel & Fleet)
- Sample Merchant Processing Application (Fuel & Fleet)
SHIFT 4 / SKYTAB
- Merchant Processing Application (Shift4 / Skytab) – *add POS System Service Agmt below
- *POS System Service Agreement (Shift4 / Skytab)
- Sample Merchant Processing Application (Shift4 / Skytab)
- Terms and Conditions (Shift 4 / Skytab)
SQUARE
- For Standard Pricing: The merchant will use this application link: http://www.valuedmerchants.com/square_standard_pricing
- For Cash Discount Pricing: The merchant will use this application link https://valuedmerchants.com/square_cash_discount
- The merchant will need to complete the application. The agent can assist, but the merchant must be present, in person.
- The merchant will need to supply:
- the bank routing and account numbers where funds will be deposited and fees will be debited,
- the merchant’s drivers license,
- a selfie will need to be taken with which the device the application is being entered,
- If needed, we have an application walk through: How to set up a new Square account (internal use only)
HIGH RISK
OTHER MERCHANT ACCOUNT DOCS
- ACH Equipment Debit Authorization Form – NEW!!
- ACH Equipment Debit Authorization Form – EXAMPLE
- Bank Change Request Form (FirstData Omaha Accounts)
- Bank Change Request Form (TSYS)
- Bank Change Request Form Sample (TSYS)
- Bank Change Request Form (Clearent)
- Bank Change Request Form Sample (Clearent)
- Bank Change Request Form (PCS – Fuel & Fleet)
- Bank Change Request Form Sample (PCS – Fuel & Fleet)
- Pricing Change Request Form (TSYS)
- Merchant Account Cancellation Form (Clearent)
- Merchant Account Cancellation Form (PCS- Fuel & Fleet)
- Merchant Account Cancellation Form (all others)