25C - AGMT MERCHANT PROCESSING SVCS

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CHASEO" Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com Pm^1pritente'ch Phone: (803) 898-8000 • Fax: (803) 898.8715 • Merchant—Services@ChasePaymentech.com SECTION 4:1099K CONTACT INFORMATION (W-4 required if new us entity and/or taxpayer to, W8 raqulred for Canadian Transaction Division's Taxpayer ID #/No. 95-6000785 Same as Corporate Yes ❑ No 1099K Contact Name Francisco Gutierrez 1099K Contact email address SECTION.4a:TRANSACTION DIVISION fgutierrez@santa-ana.org Division Name: City of Santa Ana - Dog License (up to 30 bytes - this will appear on your Financial Reports) Currency (list only i each per division): Presentment: US Settlement: us "' If using our Cross Currency Product —please provide both the Presentment and the Settlement Currencies • The following field appears on the customer's statement and Identifies the merchant name for the consumer and credit card organizations. To further aid consumer recognition, Mae has sanctioned the abbreviation of the merchant name. It must be separated from product Information by an asterisk ('), which must appear In the 4th, 8th or 13th position. The asterisk cannot be used for Retail Merchants. Internet service providers, e-commerce merchants may utilize a URL instead of Customer Service Phone If riot processing any Mall -order transactions (URL must only be 13 bytes) Cardholder Descriptor (For all card types with the exception of American Express): C 1 i 1 t I y I I o I f S I a n I t I a A n I a Customer Service Phone #: Required for Mail Order or Recurring) City: (Required for Retail) IRL: (opticnal, If phone# provided above) (13 (13 (13 7 1 4 - 6 4 7 5 4 0 0 (22 bytes) bytes) bytes) bytes) Division Location Address: 20 Civic Center Plaza Country: USA (Must be a street.address, PO Boxes not acceptable) City: Santa Ana State/Prov: I C I A Zip Code (US): 9 2 7 0 1 (For Retail -City above must match City Location) Postal Code (Intl): I I I I I IPostal Code (Can): (5 bytes) (State/Province and PoslaUZlp codes must match the address given above) Product/.Service Description (Enterproduct description, i.e. clothing, D I 0 I g L I C e n S I e !woks, membership) Publication Descriptor (Please provide only if required by your submitter): Avg. Trans. $ Amt: 25 Avg. # Trans./Yr: 3000 Projected Refund % 10 BPS How do you market this product? (Check only those that apply to this division) ❑ Catalog ❑ Direct Mail ® Internet ❑ Space Ad ❑ TV ❑ Outbound Telemarketing ❑ Other How will consumers provide credit card information to you when they order this product? (Select only one): El Retail ❑Mail/Phone(MarketingMaterial Required) Elnternet(Pteaseprovide your URL):http:// WWW.InVoiC8Cl0Ud.COm/Santa aria If Internet Is selected and the website is not yet available to consumers please complete a Marketing Material Supplement form which you may obtain from Merchant Services or your account executive. If Internet, please advise: Select one: E SSL ❑ SET ❑ No encryption method Will the consumer be able to place their order and provide their credit card info (or electronic check info) through this website? E Yes ❑ No Is the web site secure, i.e., will the information that the consumer provides, such as their name and credit card number be encrypted so that it can't be read or intercepted by other people? EYes ❑No Maximum Sale $125k Transaction Amount: (Default $25,000 U.S. dollars or established Intematlonal currency equivalent per transaction) Maximum Refund $125k Transaction Amount: (Default$25,000 U.S. dollars orestablished International currency equivalent per transaction) (Approval will be required for any temporary or permanent increases to this ceiling limit). Please check the consumer's payment option for this division: (Select only one): Revl l/18110 25C-51 NewDivlsionSetup/cboo