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CHASEblerchanl Services • 4 Northeaslerr Boulevard, Salem, NH 03079-1952 • xw:w,chasepaymentech com <br />Phone: (603) 896-E000 • Fax: (603) 8968715 • tAerchanl Services(c)ChasePaymenlech.rom <br />I Section C: FINAL DESTINATION BANK I <br />Cl I Swift Code: (8 to 11 bytes) I I I I I I I I I T I I <br />C2 I Sort Code: (Required in Great Britain <br />C3 IBAN/Bank Account # <br />Company Name: (As appears on Bank account) <br />Financial Institution Name: <br />City: State/Province: <br />Special Wire Instructions: (60 bytes) <br />Postal Code: Country: <br />Section D: INTERMEDIARY/CLEARING BANK ACCOUNT INFORMATION <br />Note: For Intl Deposits going through J.P. Morgan Chase in London, Intermediary is not required. Complete Section "C" only <br />D1 Swift Code: (8 to 11 bytes) <br />D2 Sort Code: (Required in Great Britain Only) <br />D3 Wire Transfer. (USA Only) ) <br />(Routing #) <br />D4 Financial Institution Name: <br />City: State/Province: Postal Code/Zip: <br />Country: <br />Special Wire Instructions' (60 bytes) <br />Section E: Signature <br />_ <br />'On behalf of City o` Santa Ana I, Francisco Guticmzz <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 />Finance <br />3/31/2016 <br />�� 1. a w 1 \�,_J • . _ Director of <br />Aul odzed Si nature' 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 />ATTACH VOIDED CHECK HERE <br />Rev11118.10 < New DE•riaonrcboo <br />___ 25G-86 <br />