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CHASE C6 Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • wvnv.chasepaymentech.com <br />Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant—Services@ChasePaymentech.com <br />.s4 r1v..1. i2C:I <br />SECTION 4: TRANSACTION DIVISION (continued) <br />Please check below if applicable: <br />E Bill Payment (A EX Payment transaction is a transaction foran ongoing service/billing 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 E No Do you provide custom orders at time of sale? ❑ Yes E No <br />Do you own the product at the time of sale? E Yes ❑ No <br />Do you drop ship the product? ❑ Yes E 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: <br />Phone # : <br />SECTION 5: CHARGEBACK CONTACT: (required) IQA (Manager/supervisor—one who assigns work to MCAs) <br />(Required for retail and Discover) MRQA (Managedsupervisor— one who assigns work to MRAs) <br />NOTE: This contact may receive any exception documents that may need to be mailed or faxed, if not participating in Chargeback <br />Management this will be the default contact for Chargeback Mailing second contact will not be required) <br />Location: ❑ Merchant ® Submitter ❑ Fulfillment (check one) If Submitter/Fulfillment, Name: <br />E Mr. ❑ Mrs. ❑ Ms. First Name: John Last Name: Morabito <br />Title: CTO Phone #: 703-825-3525 Ext: <br />Fax #: 877-256-8330 Alternate Fax M <br />Email Address: imorabilo@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 E ? <br />Account Masking for this contact? E Yes ❑ NO <br />Does this contact have a Paymentech Online User ID? []Yes ENo If yes, provide User ID: <br />CHARGEBACK CONTACT: (required) MCA (Merchant Chargeback Analyst — one who works the chargeback's) <br />(Required for retail and Discover MRA Merchant Retrieval Analyst— one who works the retrievals <br />® Same as above (check here if the MCA/MRA Contact is the same as the IQA/MRQA 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 A <br />Email Address: <br />Address: <br />City: StatelProv: ZiplPostal 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 />Rev11118/10 3 NewDivisionSetuplcboo <br />25C-80 <br />