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CHASEO" Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com <br />PaymentechPhone: (603) 896.6000 • Fax: (603) 896-8715 . Merchant_Services@ChasePaymentech.com <br />SECTION 4: TRANSACTION. DIVISION (continued) <br />Please check below if applicable: <br />® Bill Payment (A Bill Payment transaction is a transaction for an ongoing servicelbliling 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 ® No Do you provide custom orders at time of sale? <br />Do you own the product at the time of sale? ® Yes ❑ No <br />Do you drop ship the product? ❑ Yes ® 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: Phone #: <br />❑ Yes ® No <br />SECTION 5 CHARGEBgC4r CONTACT frequlretl) IGIA(ManagaMsuperlusor=one who assigns work to MCAs) <br />((3eq /neH for retail and Discover) MRQA (Ma'nagei'lsupervis6�- one who:assigns work to MRAs) <br />NOTE This cghtact.may receive any exception dpciimerits that may teed to be, mailed or fazed if not.participating.tri. Chargaback <br />Mana argent Is wiltbe tha default cdntae 1' r hat Marlin 'second cohtebhwtli rrotbe ie u a <br />Location: ❑ Merchant ® Submitter []Fulfillment (check one) If Submitter/Fulfillment, Name: <br />® Mr. ❑ Mrs. ❑ Ms. First Name: John Last Name: Morabito <br />Title: CTO Phone M 703-825-3525 Ext: <br />Fax #: 877-256-8330 Alternate Fax #: <br />Email Address: Imorabito@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 ® ? <br />Account Masking for this contact? ® Yes ❑ NO <br />Does this contact have a Paymentech Online User ID? ❑Yes ®No If yes, provide User ID: <br />CHA (3EB GlC-GON fAG7 `(regt)rr ,q). MCA (Merchant Ch2rgshac((AnBlyst ane who works the;:chgrgaback s) . . <br />Re illred foul fait and I)isodver MRA Merchant Retn'evalAndl'' t;- on who`works the retrievals <br />® Same as above (check here if the MCAIMRA Contact is the same as the IQAIMRQA 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 />Does this contact have a Paymentech Online User ID? ❑Yes ❑No If yes, provide User ID: <br />Rev11/18110 25C-52 NewDivisionSetupleboo <br />