Visa Disclosure


  1. A Visa member is the only entity approved to extend acceptance of Visa products directly to a merchant.
  2. A Visa member must be a principal (signer) to the Merchant Agreement.
  3. The Visa member is responsible for and must provide settlement funds to the merchant.
  4. The Visa member is responsible for all funds held in reserve that are derived from settlement.
  5. The Visa member is responsible for educating merchants on pertinent Visa International Operating Regulations with which merchants must comply.


Synovus Bank
1111 Bay Ave
Columbus, GA 31901

The responsibilities listed above do not supersede the terms of the Merchant Agreement and are provided to ensure the Merchant understands some important obligations of each party and that the Visa Member (Acquirer) is the ultimate authority should the Merchant have any problems.

American Express Disclosure

New American Express OptBlue.   New American Express ESA
By signing below, I represent that I have read and am authorized to sign and submit this application on behalf of the entity above and all information I have provided herein is true, complete, and accurate. I authorize American Express Travel Related Services Company, Inc. (“American Express”) to verify the information in this application and receive and exchange information about me personally, including by requesting reports from consumer reporting agencies.  I authorize and direct American Express to inform me directly, or through
the entity above, of reports about me that American Express has requested from consumer reporting agencies. Such information will include the name and address of the agency furnishing the report. I understand that upon American Express’ approval of the entity indicated above to accept the American Express Card, the terms and conditions for American Express® Card Acceptance (“American ExpressTerms and Conditions”) will be sent to such entity along with a Welcome Letter. By accepting the American Express Card for the purchase of goods and/or services, or otherwise indicating its intention to be bound, the entity agrees to be bound by the Terms and Conditions. By accepting the American Express Card for the purchase of goods and/or services, or otherwise indicating its intention to be bound, MERCHANT agrees to be bound by the American Express Agreement. I understand that the ISO, and BANK are not parties to the American Express Agreement.


Agreement signature: As the person signing below on behalf of the business designated on the above application as the Merchant, I certify that I am an owner, partner or officer of the Merchant and have been duly authorized to sign this application and to bind the Merchant to the MPA terms and conditions. Merchant and each  guarantor signing below hereby  acknowledge  that they  have each  received and read the MPA and  agree  to be bound  by the terms  and conditions contained in that document. Merchant certifies that all information provided in this application is true, complete and accurate. Merchant (and Guarantor when applicable) authorizes the Bank or its agents to make from time to time whatever inquiries the Bank deems appropriate to investigate and verify any of the credit, financial and other information given by Merchant for the purpose of this application, including credit references and to obtain credit reports on each person signing below. Credit or other information on Merchant, owners, officers and any guarantors of Merchant may be requested for purposes of this application and during the merchant processing relationship pursuant to the MSA. Merchant (and Guarantor when applicable) acknowledges that Bank has a legitimate business need for the information contained in any personal credit report that may be obtained in connection with this application, and that this application is a business transaction that was initiated by Merchant and/or such Guarantor. Merchant understands that the MPA shall not take effect until Merchant has been approved by Bank and a merchant  number is issued.
American Express® card transactions and other non-bank services are not provided to Merchant by Bank. Bank is not responsible, and shall have no liability, to    Merchant in anyway with respect to American Express®card transactions and non-bank services.
Merchant acknowledges that the parties may produce and rely upon a copy or electronically stored image of the merchant application and MPA for all legal purposes.
What is this form?
To help the government fight financial crime, Federal regulation requires certain financial institutions to obtain, verify, and record information about the beneficial owners of legal entity customers. Legal entities can be abused to disguise involvement in terrorist financing, money laundering, tax evasion, corruption, fraud, and other financial crimes. Requiring the disclosure of key individuals who own or control a legal entity (i.e., the beneficial owners) helps law enforcement investigate  and prosecute these crimes.
Who has to complete this form?
This form must be completed by the person opening a new account on behalf of a legal entity with any of the following U.S. financial institutions: (i) a bank or credit union; (ii) a broker or dealer in securities; (iii) a mutual fund; (iv) a futures commission merchant; or (v) an introducing broker in commodities. For the purposes of this form, a legal entity includes a corporation, limited liability company, or other entity that is created by a filing of a public document with a Secretary of State or similar office, a general partnership, and any similar business entity formed in the United States or a foreign country. Legal entity does not include sole proprietor- ships, unincorporated associations, or natural persons opening accounts on their own behalf.
What information do I have to provide?
This form requires you to provide the name, address, date of birth and Social Security number (or passport number or other similar information, in the case of foreign persons) for the following individuals (i.e., the beneficial owners): (i) Each individual, if any, who owns, directly or indirectly, 25 percent or more of the equity interests of the legal entity customer (e.g., each natural person that owns 25 percent or more of the shares of a corporation); and (ii) An individual with significant responsibility for managing the legal entity customer (e.g., a Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, or Treasurer).
The number of individuals that satisfy this definition of “beneficial owner” may vary. Under section (i), depending on the factual circumstances, up to four individuals (but as 217 few as zero) may need to be identified. Regardless of the number of individuals identified under section (i), you must provide the identifying information of one individual under section (ii). It is possible that in some circumstances the same individual might be identified under both sections (e.g., the President of Acme, Inc. who also holds a 30% equity interest). Thus, a completed form will contain the identifying information of at least one individual (under section (ii)), and up to five individuals (i.e., one individual under section (ii) and four 25 percent equity holders under section (i)). The financial institution may also ask to see a copy of a driver’s license or other identifying document for each beneficial owner listed on this form.
Persons opening an account on behalf of a legal entity must provide the following information:

Equipment / Software Disclosure

Bank is not a party to this Section and has no liability related to this Section

Please Note: Any hardware, software or Gateways provided appear on a document known as an Installation Worksheet, which is not part of this Agreement or Application. Bank or Visa Member is not Party to this Section and has no liability related to hardware, software or any gateway sold, leased or otherwise provided to Merchant.

Please identify any Party supplying merchant bankcard services as an outside Vendor who will have access to Card holder Data. Name of Vendor:                                             

Purpose of Access: