Merchant Deposit Capture Application

If you do not understand any part of the following information, an employee at any branch or at Customer Service will be happy to assist you. Phone calls may be monitored or recorded for quality control purposes. Customer Service phone numbers are as follows: 1-800-342-0679 and 1-361-275-2345.

Required Field

Employee Information

Do you perform background checks on new employees?

Is a photo ID required for employment?

Are photo IDs worn in the workplace?

Primary Applicant

Enter the name of the person authorized to agree to the contract later in the application.

Authorized Person Authorized Person's Title Social Security Number Email

Multiple Locations

Enter information about each location that will be using Merchant Source Capture™.

Location

Location Name Address City State Zip Code Expected Start Date

 Add Another Location

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 Phone Fax Email Social Security Number

Secondary Contact

Name Title Phone Fax Email Social Security Number

Deposit Corrections

Notification of any deposit corrections will be sent to either the fax number or the Email address listed.

Name Title Phone Fax Email Social Security Number

Account & Deposit Information

To open an account contact your nearest TrustTexas Bank branch location.

Account Number

Use this account as your billing account?

Use this account for the following locations

Location

 Add Another Location

Please estimate the following "average" information.

Number of Workstations

Deposit Days

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Items per Deposit Dollar Volume per day

Scanner/IT Information

Number of scanners to be used Make and Model of scanner(s)

Do you have wireless Internet access?

Is it a secured wireless connection?

What operating systems do you use on computers connected to the scanners?

Windows 7
Windows 10
Other

Please List

Do you keep updated antivirus software on your computers?

Do all computers use a firewall?

Do you perform IT audits?

If yes, please supply financial institution with a copy of latest audit.

Do you have IT staff onsite?

Do you offer VPN or remote access for staff?

Tokens

How many tokens are needed? Each person must be assigned their own token to submit Merchant Deposits.

Token User

Name Phone Email

 Add Another Token

Paper Check Handling

Do you plan to mark or "frank" each paper check after it has been successfully issued to the financial institution?

How long do you plan to store the original checks after depositing?

You must keep the original checks for a minimum of 120 days.

Check Storage Length

Will your original checks be stored in a locked and secure location after scanning?

What method will you use to securely destroy original checks after the retention period?

Destruction Method

Endorsement

I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. I authorize the Financial Institution to make any credit or investigative inquiry that the Financial Institution determines appropriate. I understand that I must update the information listed above at your request and if my financial condition changes. Primary Applicant's Signature Date

Merchant Deposit Capture Application

Company Information

Do you offer products and services outside the United States?

Have you filed for bankruptcy in the past seven years?

Does your company currrently use our Business Internet Banking system?

Does your company currently use our ACH or wire services?

Do you use Merchant Capture at another Financial Institution?

Employee Information

Do you perform background checks on new employees?

Is a photo ID required for employment?

Are photo IDs worn in the workplace?

Primary Applicant

Multiple Locations

Location

Contacts

Primary Contact

Secondary Contact

Deposit Corrections

Account & Deposit Information

Use this account as your billing account?

Use this account for the following locations

Please estimate the following "average" information.

Deposit Days

Scanner/IT Information

Do you have wireless Internet access?

Is it a secured wireless connection?

What operating systems do you use on computers connected to the scanners?

Do you keep updated antivirus software on your computers?

Do all computers use a firewall?

Do you perform IT audits?

Do you have IT staff onsite?

Do you offer VPN or remote access for staff?

Tokens

Token User

Paper Check Handling

Do you plan to mark or "frank" each paper check after it has been successfully issued to the financial institution?

How long do you plan to store the original checks after depositing?

Will your original checks be stored in a locked and secure location after scanning?

What method will you use to securely destroy original checks after the retention period?

Endorsement