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� , 1nvo1ceCloud•" <br />Biller Order Form ....,.t <br />• • . Carlyn Altheide <br />S&S <br />.. ❑ EBPP <br />® Cloud Store ® Cloud Pay ❑ IVR ❑ OBD ❑ Klosk <br />® Visa/MasterCard/Discover ❑American Express ® ACH/EFT <br />Ownership Type: Government <br />formation <br />Biller Contacts <br />Legal Name: City of Santa Ana <br />Minerva Mancha, Treasury Services Super <br />Address 1: <br />20 Civic Center Plaza <br />42Address <br />2: <br />ancha@senta-ana.org <br />=:71g.7-5 <br />City: <br />Santa Ana <br />State: <br />Ca <br />Zip: <br />92701,Hans Nielsen, Project Manager <br />Phone# <br />I 714.047.5400 <br />Fax #: <br />7148475089 Phone Number: 714-647-5442 <br />Ext. <br />Website URL: <br />I FhV—,!/ww—ci,.ra.nta-.ana.ca.us/ Email Address: hnielsen@santa ana.org <br />Business Open Date: 1886 <br />p <br />- Minerva Mancha <br />Federal Tax ID#: <br />Phone Number: 714-6475442 Ext. <br />Note: Federal Tax lD and Legal Name must match on all documents. Email Address: mmancha@santaana.org <br />Signatory Contact: Francisco GutierrezTitle: Finance Director77 <br />Phone Number. 714-647-5400 <br />Ext. Email Address: fguterrez@sante-ana.org <br />Notes/Special <br />Paperwork Contact: Will Holt, Treasury & Customer Services Manager, (714) 6475456, wholt®santoana.org <br />i <br />New Biller Implementation: $ 1500 <br />Paperless Presentment: $ 0.11 Perltem <br />--- <br />Includes 3 email notifications .-- - - <br />Biller Portal Access: $ <br />10D <br />Monthly <br />IC Payment- Credit Card: <br />$ <br />0.00 <br />Per item <br />Additional User(s) $ 000 <br />Monthly Per User <br />IC Payment- EFT/ACH: <br />$ <br />0.00 <br />Per Item <br />Online Bank Direct Access: $ <br />0,00 <br />Choose an item. <br />Online Bank Direct: <br />$025 <br />Pe <br />Go <br />Go Mobile Gateway $ 0.00 <br />Choose an item. <br />Harris Go Mobile: <br />$ <br />0.00 <br />Per Item <br />Invoice Presentment: $ 000 <br />I Monthly <br />EFT/ACH Reject: <br />$ <br />15 <br />Per Item <br />Charge Back: $ 20 00 Per Item <br />BILLER B6NK (MUST INCLUDE <br />VOIDED BUSINESS CF <br />Name of Checking ACCOunt(m ltappeorson cheakor Bank Leaes): Clly of Sanfa Ana <br />Bank 1.p, Morgan <br />i Address: 3 Park Plaza Fir 9 Irvine, CA 92814 Phone: 949 833 4081 <br />Name: --. ..... <br />_ <br />Depository Routing#: <br />Account#: <br />tions will be electronical de <br />Fees Routing#: <br />Account#: <br />nvoice an <br />a men rocess,n fee, b le 'ally deducted from this account. <br />