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CHASE 0i"' <br />Paymentech <br />Merchant Services . 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com <br />Phone: (603) 896-6000 . Fax: (603) 896-8715 • Merchant—Services@ChasePaymenlech.com <br />SECTION I O.- REPORT CENTER AND TRANSACTION HISTORY ACCESS FORM <br />1. Please be sure to Include the Information below for additional contact that requires access to Transaction <br />History and/or Paymentech Online Report Center. <br />2. Report delivery will be web based via Paymentech Online. <br />3. Please note: You, the merchant, are responsible for advising Chase Paymentech of changes in Paymentech <br />Online contacts. Chase Paymentech assumes no responsibility or liability of any kind for Merchant's failure to <br />advise Chase Paymentech of changes to or elimination of Paymentech Online Users. <br />Please be sure to complete all fields below. <br />Salutation: Check one: E Mr. ❑ Ms. ❑ Mrs. <br />Name: Robert Lapides Title: EVP <br />Phone #: 781-848-3733 Fax M 877-256-8330 <br />Address: 35 Braintree Hill Office Park, Suite 100 <br />City: Braintree State/Prov: MA ZiplPostal Code: 02184 Country: USA <br />Email Address: (4o bytes) blapides@invoicecloud.com <br />(usemame@domain.com) <br />Does this contact have a Paymentech Online User ID? ❑ Yes E No If yes, please provide User ID: <br />Does this User require access to: ❑ Reporting ❑ Transaction History E Both Account Masking E Yes ❑ No <br />For existing merchants — Is this User replacing an Individual with Paymentech Online Access? ❑ Yes ❑ No <br />If yes, who? Has this individual left the company? ❑ Yes ❑ No <br />For existing merchants — Is this User's access to be mirrored like another User Paymentech Online Access? <br />❑ Yes ❑ No <br />If yes, who? <br />Salutation: Check one: ❑ Mr. EMs. ❑ Mrs. <br />Name: Deborah Bowler Title: VP of Operations <br />Phone #: 781-848-3733 Fax #: 877-256-8330 <br />Address: 35 Braintree Hill Office Park, Suite 100 <br />City: Braintree State/Prov: MA Zip/Postal Code: 02184 Country: USA <br />Email Address: (40 bytes) dbowler@invoicecicud.com <br />(usemame @domain. com) <br />Does this contact have a Paymentech Online User ID? ❑ Yes ❑ No If yes, please provide User ID: <br />Does this User require access to: ❑ Reporting ❑ Transaction History E Both Account Masking E Yes ❑ No <br />For existing merchants — Is this User replacing an individual with Paymentech Online Access? ❑ Yes ❑ No <br />If yes, who? Has this individual left the company? ❑ Yes ❑ No <br />For existing merchants — Is this Users access to be mirrored like another User Paymentech Online Access? <br />❑ Yes ❑ No <br />If yes, who? <br />For adkli`tlollaG:tlse�s, ple�s� stt6txr"1#.aldt�lgrial'Fhrmis <br />I, Robert Lapides EVP verify that the <br />(Print Name) (Title)' <br />contact information is accurate, that I have the authority to make such a request and thus it should be used to grant <br />access for these contacts to access Transaction History and/or the Repor Center. <br />Ali- ur-1 <br />`(must be signed by Exe utive or Financial Contact) <br />Rev11/18/10 25C46-59 New Division/cboo <br />