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DocuSlgn Envelope ID: 7749OF52-CF5B-4828-AB2C-2C89947EC053 <br />14221 Dallas Patlnvay, Dallas, Texas 7S254 •4 Northeastern Blvd, Salem, NH 03079-1952 <br />CKASE PadY B Ee• 6 ec #TB Sales Phone (603) 896-8324 • Sales Fax (603) 896-8701 <br />ww ,chasepaymentech.com <br />TYPEOFENTIfY <br />[:]INDIVIDUAL/ SOLE PROPRIETOR ❑PARTNERSHIP ]--]CORPORATION ❑LLC' ®OTHER: Government <br />TYPE OF OWNERSHIP; ' IF LLC, TAXED AS: ❑DISREGARDED ENTITY <br />El PUBLIC [:1 PRIVATE C1 NON PROFIT <br />❑CORPORATION []PARTNERSHIP <br />STATE OF FORMATION CA DATEOFFORMA71ON 1/1/1886 <br />MM/DD/YYYYI <br />TRADING SYMBOL FISCALYEAR END (MM/DD/YYYY) <br />HAS MERCHANT EVER FILED BANI(RUP7CY7 IF VES, WNATCHAPTER? FILING DATE: EMERGENCE DATE: <br />❑ YES ❑ P <br />• • •: a •, , ••• • • • � ••• � , <br />Im <br />•• e , •• <br />SOCUiL SECURI V BIRTHDATE <br />NAME OR OR <br />TAX ID NUMBER DATE OF INCORPORATION <br />STREET ADDRESS TELEPHONE NUMBER <br />CITY STATE I <br />ZIP CODE <br />SIGNATURE PERCENT OWNERSHIP % <br />SOCIALSECURITY BIRTHDATE <br />NAME on OR <br />TAX ID NUMBER DATE OF INCORPORATION <br />STREET ADDRESS TELEPHONE NUMBER <br />CITY STATE 11 ZIP CODE 11 <br />SIGNATURE 11 PERCENT OWNERSHIP Ye <br />DO YOU HAVE ANY ADDITIONAL OWNERS (NOT LISTED ABOVE) THAT HAVE 10% OR GREATER OWNERSHIP? <br />❑ YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) ❑ NO <br />11 COMPANY PRESIDENT: COMPANYCFO•. <br />IS THERE ANYONE NOT LISTED ABOVE WHO HAS THE AUTHORITYTO MAKE FINANCIAL DECISIONS OR CONTROL COMPANY POLICY ON BEHALF OF YOUR BUSINESS? <br />[:]YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) ❑ NO <br />Rev 07/19 <br />Page 1 of 2 Paymentech Contract No. 063576 <br />25C-31 <br />COMPANY LEGAL NAME: <br />City of Santa Ana <br />TAXPAYER ID <br />95-6000785 <br />REGISTERED 7RADE <br />YEAR BUSINESS STARTED <br />NAME <br />PHYSICAL STREETADDRESS: <br />20 Civic Center Plaza <br />(NO PO BOX OR PAI D MAIL BOX) <br />CITY 11 <br />Santa Ana <br />STATE <br />CA <br />ZIP CODE <br />92701 <br />PRIMARY CONTACT <br />Francisco Gutierrez <br />TELEPHONEN <br />714.647-5200 <br />TYPEOFENTIfY <br />[:]INDIVIDUAL/ SOLE PROPRIETOR ❑PARTNERSHIP ]--]CORPORATION ❑LLC' ®OTHER: Government <br />TYPE OF OWNERSHIP; ' IF LLC, TAXED AS: ❑DISREGARDED ENTITY <br />El PUBLIC [:1 PRIVATE C1 NON PROFIT <br />❑CORPORATION []PARTNERSHIP <br />STATE OF FORMATION CA DATEOFFORMA71ON 1/1/1886 <br />MM/DD/YYYYI <br />TRADING SYMBOL FISCALYEAR END (MM/DD/YYYY) <br />HAS MERCHANT EVER FILED BANI(RUP7CY7 IF VES, WNATCHAPTER? FILING DATE: EMERGENCE DATE: <br />❑ YES ❑ P <br />• • •: a •, , ••• • • • � ••• � , <br />Im <br />•• e , •• <br />SOCUiL SECURI V BIRTHDATE <br />NAME OR OR <br />TAX ID NUMBER DATE OF INCORPORATION <br />STREET ADDRESS TELEPHONE NUMBER <br />CITY STATE I <br />ZIP CODE <br />SIGNATURE PERCENT OWNERSHIP % <br />SOCIALSECURITY BIRTHDATE <br />NAME on OR <br />TAX ID NUMBER DATE OF INCORPORATION <br />STREET ADDRESS TELEPHONE NUMBER <br />CITY STATE 11 ZIP CODE 11 <br />SIGNATURE 11 PERCENT OWNERSHIP Ye <br />DO YOU HAVE ANY ADDITIONAL OWNERS (NOT LISTED ABOVE) THAT HAVE 10% OR GREATER OWNERSHIP? <br />❑ YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) ❑ NO <br />11 COMPANY PRESIDENT: COMPANYCFO•. <br />IS THERE ANYONE NOT LISTED ABOVE WHO HAS THE AUTHORITYTO MAKE FINANCIAL DECISIONS OR CONTROL COMPANY POLICY ON BEHALF OF YOUR BUSINESS? <br />[:]YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) ❑ NO <br />Rev 07/19 <br />Page 1 of 2 Paymentech Contract No. 063576 <br />25C-31 <br />