Merchant Affiliate Transactions Entry Form
(Fax Entries)

  ClubBucks ID Number Purchase Amount (Exclude Tax) Date
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Enter ClubBucks transactions on this form, then FAX these transactions to The DHS Club/Merchant Transactions 941-475-4081.
Transactions must be submitted within 24 hours of the purchase being made. I understand that the DHS Club will charge $0.10 (10 cents) USD per transction entered and draft my account, as specified on my Merchant Application, for payment of these transaction fees.

Fees will be collected on the 5th of the month for transactions posted for the previous month.

Merchant Affiliate ID Number/ UserName/Password: _____________/___________/_____________ Signature:_____________________________

More than one location?
Enter Location ID: _______________________

 Print Name: ___________________________
Fax to: The DHS Club/ Merchant Transactions FAX: 941-475-4081