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CHASE CP <br />.3 <br />Merchant Services • 4 Northeastern Boulevard, Salem. NH 03079-1952 • www.chasepaymentech.com <br />Phone: (603) 896-6000 • Fax: (603) 896-8715 - Metch.ant—SeNices@ChasePaymentech.com <br />SECTION 8: PROCESSING METHOD continued <br />[15. Will you be using a Point-of-sale terminal (US & Canada only) or Point -of -Sale software? <br />Point of Sales Software: <br />POS/Software Name: Host Capture ❑ Terminal Capture ❑ <br />Connectivity: Dial ❑ NetConnect❑ (If Netconnect see requirements below) <br />If NetConnect: Where is your software hosted/configured? Corporate location❑ or Division location❑ <br />NetConnect Contact Name: Email address: <br />Userld if existing: Phone: <br />PIN Pad Type and quantity?(for PIN BASE DEBIT Only) Quantity: <br />Is PIN Pad Existing ❑ or PIN Pad Purchase Needed❑ <br />Injection —Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key? ❑ <br />Who will be injecting the Encryption Key into your PIN Pad? Please select one below: <br />❑ Chase Paymentech Solutions ❑ Other Vendor Name: <br />Eau iomentlTermin als: <br />Will you ❑ Purchase? ❑ Rent? (US Only) If purchase or rent, date needed by: <br />❑ Use existing equipment? ❑ Yes ❑ No Terminal quantity? Printer quantity? <br />Terminal/Equipment Type: Printer Type: <br />Host Capture ❑ Terminal Capture ❑ <br />Connectivity: Dial ❑ NetConnect ❑ Wireless ❑ (n Netconnect see requirementbelowJ <br />NetConnect Contact Name: Email address: <br />Userld If existing: Phone: <br />PIN Pad Type and quantity? (for PIN BASEOEB1TOniy) Quantity: <br />Is PIN Pad Existing ❑ or PIN Pad Purchase Needed❑ <br />Injection —Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key? ❑ <br />Who will be injecting the Encryption Key into your PIN Pad? Please select one below: <br />❑ Chase Paymentech Solutions ❑ Other Vendor Name: <br />Store Phone #: Terminal Line Phone #: Dial Out Prefix (9,8,5): <br />Customer Service Phone # (if different then Store Phone #) <br />Equipment/Kits/Imprinters Ship To Address (if different than store Attention to: <br />location) Please ensure a contact will be available to accept shipment: <br />Default will be Store Manager <br />Street Address: <br />City: State/Prov: Zip/Postal Code: Country: <br />Ship to contact's phone#: Ship to contact's email: <br />Store Opening Date: Special Requirements: <br />Do you require a "re -program" kit? (overlay, quick reference guide, etc.) Yes❑ No❑ <br />Do you require an Imprinter? ❑Yes ❑No Type of Imprinter required: With Dater ❑ or Without Dater ❑ <br />Do you require an Imprinter Plate? ❑Yes ❑No <br />Do you require a Welcome Kit? (this includes sales drafts, credit drafts, etc) Yes❑ No❑ <br />Rev11/18/10 7 New Divisiontcboo <br />25C-84 <br />