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CHASE C ' Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com <br />Paymentech Phone: (603) 896.6000. Fax: (603) 898-8715 • Merchant_Services@ChasePaymentech.com <br />4: <br />Please check below if applicable: <br />E Bill Payment (A Bill Payment transaction Ise transaction loran ongoing service/billing cycle that is known and agreed upon in <br />advance by the merchant and cardholder. i.e. Membership or Insurance, etc.) <br />Do you stock product? ❑ Yes E No Do you provide custom orders at time of sale? ❑ Yes E No <br />Do you own the product at the time of sale? E Yes ❑ No <br />Do you drop ship the product? ❑ Yes E No If yes, what %: <br />Are you filling your own merchandise orders? E Yes ❑ No <br />If no, who is your fulfillment service bureau? <br />Fulfillment Contact: <br />Phone # : <br />SECTION 5 CHARGEBACK CONTACT (required) IQA.('Managerlsupernsor=onewho assigns work to MCAs). <br />(Required lorietall and Discover) MRQA (Afanager/supervr, or= one who assigns Wor 6 MRAs) <br />NOTE. Thl9 cdntact may receive any exception documer)ts ihafrh y need tp tie mailed ar,'fexed, if ndt particlpet ngrlri_Chargeback;. <br />Mans' ementthis will be the default coritactfor Cha ebaek Mailin ; second co : ct. Ill not tie re ulred <br />Location: ❑ Merchant E Submitter ❑ Fulfillment (check one) If Submitter/Fulfillment, Name: <br />E Mr. ❑ Mrs. ❑ Ms. First Name: John Last Name: Morabito <br />Title: CTO Phone #: 703-825-3525 Ext: <br />Fax #: 877-256-8330 Alternate Fax M <br />Email Address: jmorabito@invoicecloud.com <br />Address: 1815 Beulah Rd <br />City: Vienna State/Prov: VA Zip/Postal Code: 22182 Country: USA <br />Will this contact require access to: Transaction History ❑ Report Center ❑ both E ? <br />Account Masking for this contact? E Yes ❑ NO <br />Does this contact have a Paymentech Online User ID? []Yes ENo If yes, provide User ID: <br />CHAREBAGK,COCyTAG7 (regt»Eetl)MCA(kierC/tantitargohac{rYtalyst tineiihpworks:the,chatgetracksJ <br />Ra rt�r"¢'diarrelailandDtscoYe! MR14 lNdCch9nERelrievalArie sf tln3who-worksthe,retnevale <br />E Same as above (check here if the MCA/MRA Contact is the same as the IQA/MRQA contact) <br />Location: ❑ Merchant ❑ Submitter ❑ Fulfillment (check one) If Submitter/Fulfillment, Name: <br />❑ Mr. ❑ Mrs. ❑ Ms. First Name: Last Name: <br />Title: Phone #: Ext: <br />Fax #: Alternate Fax #: <br />Email Address: <br />Address: <br />City: State/Prov: Zip/Postal Code: Country: <br />Will this contact require access to: Transaction History ❑ Report Center ❑ both ❑ ? <br />Account Masking for this contact? ❑ Yes ❑ No <br />Dees this contact have a Paymentech Online User ID? ❑Yes ❑No If yes, provide User ID: <br />Rev11 /18/10 25C-42 NewCivlslonSetup/obco <br />