TDS Enrollment Form
Status
Won
Lost
Supplier Remorse
Open
Return
Won/Converted
Reason
Acquiring Prospect
Alt Pmt Method
App In Progress
Auto Enroll
Better Contact Information
BIP Full Acquiring
BIP MID
BIP No MID
Call
CANCELLED
Client Discount
Contractual Term
Customer Acct #
Do Not Call
Email
Enroll Email
Enroll Form
Full Acquiring
Inactive Client
Max Attempts
No Discounts Accepted
No Longer in Business
Non Acceptor
Not Preferred
Not Started
ON HOLD
Processing Limit
Require Invoice #
Research
Rework Lead
SE ENROLL
SE FULL ACQUIRING
SE MID
Supplier Remorse
Surcharge/Fees
Validate with Client
Verbal
Voicemail
Enroll Date
Win Date
Company
*
First Name
*
Last Name
*
Email
*
Street
*
PO BOX 935359
City
*
State/Province Code
*
AK
AL
AB
AR
ACT
AZ
BC
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NB
NL
NSW
NH
NJ
NM
NT
NT
NS
NU
NV
NY
OH
OK
ON
OR
PA
PR
PE
QC
QLD
RI
SK
SC
SD
SA
TAS
TN
TX
UT
VA
VI
VIC
VT
WA
WA
WI
WV
WY
YT
Postal Code
*
Phone
*
Payment Remittance Email
*
Please answer the questions below:
Our company accepts virtual credit card payments from all buyers. There are no fees or other stipulations to this acceptance.
*
--select an item--
Yes
No
Buyers wanting to pay our company by virtual card in the future may be automatically enrolled.
*
--select an item--
Yes
No
* I understand there is an interchange rate that is assessed by my merchant bank. There will be no additional charges or fees assessed by US bank or TDS.
* Contact us at TDS@b2bepayables.com or call us at 844-279-8860. Our fax number is 855-859-6873.
Supplier ID