Merchant Deposit Service
Merchant Deposit Service utilizes a desktop scanner that connects to your PC and the Internet. With it, you can scan checks received from customers and issue deposits electronically to Community Bank, anytime day or night. It’s the fastest way to turn check deposits into cash.

Merchant Deposit Service is provided to qualifying businesses that have an established account with Community Bank. This online application is used to assist us in gather information to qualify your business for this service. You will also be asked to furnish additional information regarding your company’s finances. If you do not understand any part of the following information, an eBanking Representative will be happy to assist you. Please contact us during normal business hours at 985.537.5283 x6381.

Company Information
Legal Name of Business:
Company / Doing Business As: (optional)
Website Address:
Number of years in business:
Number of years at Community Bank:
Business Address:
City:
State:
Zip Code:
 
Business Phone:
Business Fax:
Primary Applicant's Direct Phone:
Federal Tax ID#:
Mailing Address: Please complete only if different from Business Address entered above.
City:
State:
Zip Code:
 
Do you offer products and services outside the United States? Yes No  
If yes, list countries:
Have you filed for bankruptcy in the past seven years? Yes No  
Does your company currently use our Business Online Banking system? Yes No  
Does your company currently use our online ACH or wire services? Yes No  

Primary Applicant
Enter the name of the person authorized to agree to the contract later in the application.
Authorized Person:
Authorized Person's Title:
Email:
SSN:

Multiple Locations
Enter information about each location that will be using Community Bank's Merchant Source Capture.
Company Name:
Location Name:
Location Address:
City:
State:
Zip Code:
 
Expected Start Date:
Merchant Source Capture Start-up Kit Email:

* The bank may utilize your financial soundness, length of current banking relationship, and volume of current return items to determine eligibility for this product.


Contacts
The Primary Contact information is required. All other contacts are optional and will be filled in with the Primary Contact information if none are provided.
Primary Contact
Name:
Title:
SSN:
Phone:
Fax:
Email:
Secondary Contact
Name:
Title:
SSN:
Phone:
Fax:
Email:
Additional User 1
Name:
Title:
SSN:
Phone:
Fax:
Email:
Additional User 2
Name:
Title:
SSN:
Phone:
Fax:
Email:
Additional User 3
Name:
Title:
SSN:
Phone:
Fax:
Email:
Additional User 4
Name:
Title:
SSN:
Phone:
Fax:
Email:
Additional User 5
Name:
Title:
SSN:
Phone:
Fax:
Email:

Account & Deposit Information
Account #: (To open an account contact your nearest Community Bank branch location.)
If you would like use a different account as your billing account, please indicate here:
Billing Account: (if Different from above)
Please estimate the following "average" information. This will assist us in determining your needs.
Number of Workstations:
Deposit Days: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Check either Yes or No Yes  No Yes  No Yes  No Yes  No Yes  No Yes  No Yes  No
Estimated Items per Deposit:
Estimated Dollar Volume per day:

Pricing Options
Community Bank Offers two scanning options depending on your needs. Option 1 is a single check feed scanner that is perfect for smaller volume deposits. Option 2 includes a multi item feed scanner for larger volume depositors.

Scanner Pricing
Option 1
Single Feed Scanner
Scanner Fee = $300
Option 2
Multi Feed Scanner
Scanner Fee = $830
 
Other Fees
Monthly Fee $29.99
Per item Fee $.08
Initial Setup Fee $65

Training Options
Initial Onsite Training Free
Ongoing Telephone Support Free
Additional Onsite Training
(After 90 Days from implementation)
$35 Per Visit