Hawaii State Procurement Office



Merchant Services/Payment GatewayCompetitive Sealed Bidding(Invitation for Bid, IFB)State of HawaiiDepartment of Human ServicesMed-QUEST DivisionATTACHMENT 1BID WORKSHEETPayment Gateway Fee WorksheetPayment methodFee (percentage of transaction)Transaction FeeOnline transaction (in the US)Online transaction (outside the US)In location transaction (in the US)Fee (percentage of transaction)Fixed feeMonthly Service fees (if any) (itemize)(Example: Fraud protection, recurring fee…)Equipment Fee (Option)Fee (percentage or cost of transaction)Monthly FeeNon-recurring Cost (NCR)Physical TerminalVirtual TerminalInternational SalesChargeback FeeUncaptured AuthorizationCard Verification TransactionsRefund FeeAmerican Express? card usage feesMerchant Services Fee WorksheetFees by card (List any variations i.e. fees for reward cards…)VisaMasterCardDiscoverAmerican ExpressInterchange ReimbursementFlat per transaction feeNetwork FeesOther feesMonthlyYearlyNon-RecurringMerchant Account application feeSetup FeePCI Compliance FeeEquipment Programming fee (Option)Terminal Fee (Option)PCI FeeAnnual feeEarly termination feeMonthly feeStatement feeIRS reporting feeOnline reporting feeNetwork FeeAddress Verification Service (AVS)Retrieval Request FeeChargeback feeBatch feeNSF fee ................
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