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CHASE 0" <br />Paymentech <br />C1 Swift Code: (8 to 11 b, <br />C2 Sort Code: (Required <br />C3 IBAN/Bank Account # <br />Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079.1952 • www.chasepaymentech.com <br />Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant—Servlces@ChasePaymentech.com <br />BANK <br />In Great Britain Only) <br />Company Name: (As appears on Bank account) <br />Financial Institution Name: <br />City: State/Province: <br />Special Wlre Instructlons: (60 bytes) <br />Postal Code: Country: <br />Sectit ri. D tN'r fRMEO[ARY/CLEARIMG.BANK ACCOUNT <br />INFORMATIgN_ <br />jV io:.Fbrinr1..0e @sits-poing thou hJ.P. ma ed cfiaseirt London; Intermedia <br />'tis: not re uired,.: Complete. Section*'C•onl <br />131 <br />8 f Code: (8 to 11 bytes) <br />D2 Sort Code: (Required In Great Britain Only) <br />D3 Wire Transfer: (USA Only) <br />(Routing #) <br />04 Financial Institution Name: <br />City: State/Province: Postal Code/Zip: <br />Country: <br />Special Wire Instructions: (60 bytes) <br />Sedan E. Si Mature <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 />�����r l Finance Director <br />���23'LOti <br />Authodzed Signature* Title <br />Date <br />("Must be signed by 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 />I <br />ATTACH VOIDED CHECK HERE <br />------------------------------------------------------------------------------ --------------------------------------- <br />Rev11/18/10 25C-68 New Divislon/cboo <br />