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CHASE ! pPaymentech <br />Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www,chasepaymentech.com <br />Phone: (503) 896-6000 • Fax (603) 896.8715 • Merchant_Services@ChasePaymentech.com <br />SECTION 10: 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: ® Mr. ❑ Ms. ❑ Mrs. <br />Name: Robert Lapides Title: EVP <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) blapides@involcecloud.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 ® Both Account Masking ® 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: Checkone: ❑ Mr. ® Ms. ❑ 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@invoicecloud.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 ® Both Account Masking ® 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 />Foz<aditloilallJS@rs, please subtrilt.adcitttgnal'farrtis <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 Report enter, <br />S griat9Ye �4A11t c-„�o <br />77-, : <br />"(must be signed by ExecuMve or Financial Contact) <br />Rev11/18/10 25C-69 New Divislon/cboo <br />