|
CHASE 00"
<br />Paymel`Is eel
<br />Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079.1952 • www.chasepaymentech.com
<br />Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.ccm
<br />Note: When settino un multiple bank accounts. olease complete a separate form for each.
<br />SECTI0N`9::BANK. ACCOUNT INFORMATION'
<br />Checkoniy.one
<br />Settlement Currency in which:we .
<br />Deposit
<br />Complete altsections.,.
<br />: of the 7 optloAs
<br />will fund to you '
<br />. (Countrywhere youi:Bank Acct
<br />Ilsted
<br />below' .
<br />(FedwireVRouting #)
<br />Resides) ..
<br />Option #10
<br />USD
<br />USA
<br />A. E
<br />See section A Note section
<br />Option W ❑
<br />CAD
<br />CAN
<br />B1 to B3, E
<br />Option #3 ❑
<br />USD
<br />CAN
<br />131 to B3, D3, D4 E
<br />Option #4 ❑
<br />USD
<br />Int'I
<br />C1 to C3, 131, D3, D4, E
<br />list country funds are being deposited In
<br />Option #5 ❑
<br />❑Euro, []GBP, ❑ JPY, ❑AUD, ❑
<br />Euro Bank or SAME as
<br />C1 and/or C2, C3, E
<br />HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK,
<br />presentment/settlement currency
<br />❑NZD, ❑ZAR
<br />Option # 6 ❑
<br />❑Euro, []GBP, ❑ JPY, ❑AUD, ❑
<br />If DIFFERENT than Settlement
<br />C1 and/or C2, C3, D1
<br />HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK,
<br />Currency
<br />and/or D2, D4, E
<br />❑NZD, ❑ZAR, ❑USD
<br />Int'I
<br />list country funds are being deposited in
<br />Option #7 ❑
<br />❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑
<br />CAN
<br />B1 to B3, D1, D4, E
<br />HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK,
<br />❑NZD, ❑ZAR
<br />St:ctui i -A. , US BANK AOCOONt INFQRMATI,QN
<br />select only one method of transfer
<br />® ACH Transfer 3 2 2 2
<br />7
<br />1 6 2
<br />7 (ABA #)
<br />❑ Wire Transfer (See Note)
<br />(FedwireVRouting #)
<br />❑ Swift Transfer (See Note)
<br />(Swift Code: (s to t1 bytes)
<br />Please Note: Swift code Is required ifyour division is located outside of the US or Canada and is settling funds in USD.
<br />Wire transfer requires both ACH ABA# and FedwireWRoutin #.
<br />Special Wire Instructions: 60 bytes)
<br />Bank Account #: 935309500 Company Name: (As appears on Bank Account)
<br />Financial Institution Name: J.P Morgan
<br />City: Irvine State: CA Zip/Postal Code: 92614
<br />® Checking OR ❑ Savings
<br />City of Santa Ana
<br />Country: United States
<br />61 Institution Number:
<br />B2 Swift Code: (a to 11 bytes)
<br />133 Bank Account#
<br />Financial Institution Name:
<br />City: Province:
<br />❑ Checking OR ❑ Savings
<br />EFT Branch Transit Number:
<br />I I I i I I I I I (required If settlement is USD)
<br />Company Name: (As appears on Bank Account)
<br />Postal Code: Country: Canada
<br />Rev11 /18/10 25q-57 New Division/cboo
<br />
|