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CHASE moi,„ <br />p alt' entech <br />Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079.1952 • www.chasepaymentech.com <br />Phone: (603) 896-6000 • Fax: (603) 896-8715 • Marchant—Services@ChasePaymentech.com <br />C1 Swift Code: (8 to 11 bytes) <br />C2 Sort Code: (Required in Great Britain <br />C3 IBANBank Account # <br />Company Name: (As appears on Bank account) <br />Financial Institution Name: <br />City: State/Province: <br />Special Wire Instructions: (60 bytes) <br />Postal Code: Country: <br />5ebtiofiD: INTfRMEDIARYICLEARINGBAN'FCA GOUNtIN�4)R.MA1fQN <br />-Note: 'r-grint'Ipe o'9&olnh:dlYaU hJ.t+Mor Bh Chase.iri Lond-n ddtarmedl <br />is'dq(re aired �Cdrir <br />7afe S9CUoii C'.onl <br />D1 <br />Swift Code: (8 to 11 bytes) <br />D2 Sort Code: (Required in Great Britain Only) <br />D3 Wire Transfer: (USA Only) <br />(Routing #) <br />D4 Financial Institution Name: <br />City: State/Province: Postal Code/Zip: <br />Country: <br />Special Wire Instructions: (60 bytes) <br />�eai♦on E 5t nai;ure .. .:. _. . <br />'On behalf of City of Santa Ana I, Francisco Gutierrez <br />represent and warrant <br />(Merchant Legal Name) (Print Name) <br />that I have the authority to add banking information and I verify that the above banking information Is accurate and should be used to <br />transfer funds accordingly." <br />Finance Director <br />Authorized Signature* Title <br />Date <br />(-must De signed ay Executive or Financial contact) <br />Note: In order to process this request, please attach an original voided check (starter check or bank <br />statements not applicable) or a bank letter of verification. <br />-•_----------------------------------------------------------------------------------------------------------------- <br />ATTACH VOIDED CHECK HERE <br />Rev11/18110 25C-48 New Division/cboo <br />