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DocuSlgn Envelope ID: 7749OF52-CF5B-4828-AB2C-2CS9947EC058 <br />14221 Dallas Parkway, Dallas, Texas 7S254 • 4 Northeastern Blvd, Salem, NH 03079-1952 <br />(ki Sales Phone (603) 8968324 + Sales Fax (603) 896-8701 <br />www.chasepaymentech.com <br />COMPANY LEGAL NAME: City of Santa Ana TAXPAYER ID 95-6000785 <br />REGISTERED TRADE <br />NAME YEAR BUSINESS STARTED <br />PHYSICAL. STREET ADDRESS: 20 C(VIC Centex Plaza <br />NO PO BOX OR PAID MAIL BOX) <br />CITY Santa Ana sraTe CA ZIP CODE 92701 <br />PRIMARY CONTACT FrB nCISC0 CU11 E!YY2Z TELEPHONEN 714.647-5200 <br />TYPE OF ENTITY <br />[]INDIVIDUAL/SOLE PROPRIE'rOR []PARTNERSHIP []CORPORATION ❑LLC* Roum Government <br />TYPE OF OWNERSHIP; * IF LLC, TAXED AS: ❑DISREGARDED ENTITY <br />[] PUBLIC [] PRIVATE [] NON PROPI'T [CORPORATION []PARTNERSHIP <br />STATE OF FORMATION O,Q DATE OF FORMATION 1�1�18&6 <br />(MM/DD/YYYY) <br />TRADING SYMBOL FISCAL YEAR END (MM/DD/YYYY) <br />HAS MERCHANT EVER PILED BANKRUPTCY? IF YES, WHAT CHAPTER? PILING DATE, EMERGENCE DATE: <br />I—I YES F] NO 11 <br />SOCIAL SECURITY BIRTHDATE <br />NAME OR OR <br />TAX ID NUMBER DATE OF INCORPORATION <br />STREET ADDRESS TELEPHONE NUMBER <br />CITY STATE ZIP CODE <br />SIGNATURE PERCENTOWNERSNIP <br />NAMB SOCIALSSE URITY BIRTHRATE <br />on 11 11 <br />STREETADDRESS I TELEPHONENUMSER <br />CITY STATE—_---�J ZIP CODE <br />SIGNATURE pERCENF OWNERSWP V <br />DO YOU HAVE ANY ADDITIONAL OWNERS (NOT LISTED ABOVE) THAT HAVE 109/ OR GREATER OWNERSHIP? <br />© YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) [] NO <br />COMPANYPRESIDENT: I COMPANY CFO: <br />is rHERE ANVONE NOT LISTED ABOVE WHO HA. TFIE AUTHORITY TO MAKE FINANCIAL DECISIONS OR CONTROL COMPANY POLICY ON BEHALF OFYOURLBUSION:ESF? J <br />[] YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILT. PROVIDE)_ <br />PRI301 of 2 Paymenteeli Contract No, 063576 <br />