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InvoiceCloud" <br />Invoice Parameters <br />Biller Order Form,,,, <br />• • Business License <br />• • 11/19/2015 <br />In voicing Parameters sheet must be com lefed for each Invoice e. <br />• In-house • • Non -Submitter <br />• • • EVisa E MasterCard E Discover ❑Amex ®EFT/ACH <br />• • ❑EBPP ECloud Store ❑ Cloud Pay ❑ OBD ❑ IVR ❑Kiosk <br />Billing Frequency: Monthly Number of Bills: 200 <br />Number of Cycles: <br />nla Number of Installments: <br />1 <br />Average Invoice Amount: <br />$380 Highest Invoice Amount: <br />$ <br />30,000 <br />Billing Months (please select the applicable months below): <br />[]Jan []Feb ❑Mar ❑Apr ❑May ❑Jun ❑ Jul ❑ Aug ❑ Sept []Oct ❑ Nov ❑ Dec E All <br />• •• ❑Id -loth ❑ 11th -20th 021^-31• <br />• ❑ Biller ❑ Template ❑ Bill Print Vendor please complete below <br />.. <br />F. <br />Hardware: Choose an item. QTY Choose an item. Provided by: 11 Sales Rep 11 Operations <br />Per Unit Price: $ Shipping Address: <br />- - -- (if different than location address) <br />' <br />Total Due: $ i <br />$16rvicds Fees <br />_......... ..... ........_._..._.. <br />Selectfrom Me below to indicate.ifthe service feewillhe poldbythe <br />Item Paid by plaXer Item <br />Payer or ifBirlerwitil obsorb tee. <br />Paid b Biiler <br />❑ <br />Credit Card: ® Credit Interchange, fees, dues assessments+ <br />. :%with$ - !Minimum Card: Authorization $ 0.20; + 50I BP <br />❑ <br />EFT/ACH: $ peritem ® EFT/ACH: $ 0.50 per item <br />_ <br />❑ Flex Pay ACH: $ per item ❑ Flex Pay ACH: $ per item <br />Invoice Type % <br />Item Paid by payer Item Paid vy BIIIer <br />❑ Credit Card: ❑ Credit <br />Interchange, fees, dues assessments+ <br />'%with - Minimum Card: <br />Visa Acceptance) <br />Authorization $ + F7 7- BF <br />(Without <br />❑ EFT/ACH: $ Per item ❑ EFT/ACH: $[77 Per Item <br />❑ Credit Card Service Fee: $ Max Cap for Credit Cards: $ <br />F_. . _ . , <br />❑ EFT/ACH: Service Fee: $ ❑ ?old by payer ❑ Paid by Biller <br />Responseinteractive voice <br />❑ Paid by payer Service Fee + $ ❑ Paid by Biller 1 $ per item surcharge <br />i/Special Handling <br />Business License Cloud Store requires a cusbm lockbox file. City Will provide the exact specificafions for the file and form at Pricing for <br />development is listed on page 1 of this BOF. <br />1 Biller Requested - 12/14/2015 Hans Nielsen <br />Please note the above requested date is not guaranteed. The implementation time frame is not guaranteed subject to change and delays to <br />workload, s tems/data requirements, biller cooperation and otherfactors. <br />25C-29 <br />