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CHASE <br />J <br />Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 - wnw.chasepaymenlech.com <br />Phone: (603) 898.6000 - Fax: (603) 896-8715 • Merchant_Services@ChasePaymenlech.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@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 Users access to be mirrored like another User Paymentech Online Access? <br />❑ Yes ❑ No <br />If yes, who? <br />Salutation: Check one: ❑ 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 ZiplPostal Code: 02184 Country: USA <br />Email Address: (40bytes; dbowler@invoicecloud.com <br />(usemame@domain. ccm) <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 />For additional Users, please submit additional forms. <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 andlor the eport Center. <br />� ( <br />Signature: i c�/f✓ { <br />'(must be slgned Ly Executive or Financial Contact) <br />Rev1111.8110 10 New DivisioNcboo <br />25C-87 <br />