Provider Identity
Legal name, DBA, business address, and regulatory registration numbers where applicable.
A properly completed Legal PSP Disclosure Form reduces ambiguity about who controls funds, who bears fees and losses, and how confidential or regulated data will be handled. It supports statutory compliance, strengthens enforceability of payment arrangements, and creates a defensible audit trail for disputes or regulatory review.
The form is used by counterparties that send or receive funds through a PSP, in-house treasury teams, third-party escrow agents, counsel, and compliance officers.
Use the form early in contract formation or when a new payment channel is added to avoid downstream disputes and ensure required consumer or institutional notices are delivered.
An officer or designated agent with authority to bind the payment service provider. The signer confirms fees, controls over funds, data-handling commitments, and acceptance of responsibility for the described services.
A client officer, controller, or authorized agent who accepts the PSP terms on behalf of the payer/recipient and confirms the accuracy of business identity, account details, and consent to electronic delivery where required.
Legal name, DBA, business address, and regulatory registration numbers where applicable.
Specific payment, settlement, escrow, or reconciliation activities the PSP will perform and any excluded services.
Itemized fees, fee timing, chargeback handling, and who is responsible for network or interchange costs.
Whether funds are held in trust, commingled, or remitted immediately; timing of settlement and reconciliation procedures.
Types of data collected, retention period, security measures, and HIPAA or other compliance notes when applicable.
Notice procedures, limitation of liability clauses, indemnities, and applicable governing law.
| Field | Configuration |
|---|---|
| Signature order | Sequential or parallel routing |
| Authentication | Email + SMS code or KBA as needed |
| Attachments | Attach fee schedules or licenses |
| Retention hook | Auto-archive to records system |
Confirm your platform supports secure upload, audit trails, and integrations before issuing the disclosure.
Ensure the platform provides tamper-evident storage, role-based access, and an exportable audit trail for compliance reviews.
Provide prior to first settlement or as contract specifies
Follow IRS reporting deadlines for 1099s (Jan 31 or as required)
Retention triggers from execution date
Follow contract notice windows for chargeback or reconciliation
Meet state licensing or registration renewal dates
Prepare the initial disclosure and attach supporting documents.
Legal and finance approve language and fees.
PSP or client reviews and signs the form.
Store executed copies in records system and set retention triggers.
| signNow | DocuSign | Adobe Sign | PandaDoc | HelloSign | |
|---|---|---|---|---|---|
| Starting Price | $8/user/mo | $15/user/mo | $14/user/mo | $19/user/mo | $15/user/mo |
| Free Trial | 7-day free trial | Varies by plan | Varies by plan | Varies by plan | Varies by plan |
| Bulk Send | Yes | Yes | Yes | Yes | No |
| Audit Trail | Yes | Yes | Yes | Yes | Yes |
| HIPAA Compliant | Yes | Yes | Yes | No | No |
Optica used a concise disclosure to document escrow handling and fee splits for investor contributions
Martin Properties implemented a disclosure when using a third-party payment processor for rent collections