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CHASE 000 Merchant Services • 4 Northeastern Boulevard, Salem, Mid 03079-1952 . www.chasepaymentech,com Paymentech Phone: (603) 896.6000 • Fax: (603) 896-8715 . Merchant—Services@ChasePaymentech.com Please check below if applicable: E Bill Payment (A Blll Payment transaction is a transaction for an ongoing service/billing cycle that is known and agreed upon in advance by the merchant and cardholder. i.e. Membership or Insurance, etc,) Do you stock product? ❑ Yes E No Do you provide custom orders at time of sale? ❑ Yes E No Do you own the product at the time of sale? ® Yes ❑ No Do you drop ship the product? ❑ Yes ® No If yes, what %: Are you filling your own merchandise orders? E Yes ❑ No If no, who is your fulfillment service bureau? Fulfillment Contact: Phone # SECTION 5: CHARGEBACK CONTACT: (required) IQA (Managerlsupervisor— one who assigns work to MCAs) (Required for retell and Discover) MRQA (Menager/supervisor— one who assigns work to MRAs) NOTE: This contact may receive any exception documents that may need to be mailed or'faxed, if not participating 1n Chargeback Mana; sment this will be the defaultcontact for Char ebaok Mallin ; second contastWill not dere uired Location: ❑ Merchant E Submitter ❑ Fulfillment (check ono) If Submitter/Fulfillment, Name: E Mr, ❑ Mrs. ❑ Ms. First Name: John Last Name: Morabito Title: CTO Phone #: 703-825-3525 Ext: Fax #: 877-256-8330 Alternate Fax #: Email Address: jmorabito@invoicecloud,com Address: 1815 Beulah Rd City: Vienna State/Prov: VA Zip/Postal Code: 22182 Country: USA Will this contact require access to: Transaction History ❑ Report Center ❑ both E ? Account Masking for this contact? E Yes ❑ NO Does this contact have a Paymentech Online User ID? ❑Yes ENo If yes, provide User ID: CHARGEBACK CONTACT(requiladl) MCA (Merchant Ohprgebac( AOIyst—ane whp works the chargebeck"s) fRaqutred fcrretell'a D&OOvod MRA ((Morottrant Retrieval Ah*if— whrl works the retrievals) ® Same as above (check here if the MCA/MRA Contact is the same as the IQA/MRQA contact) Location: ❑ Merchant ❑ Submitter ❑ Fulfillment (check one) If Submitter/Fulfillment, Name: ❑ Mr. ❑ Mrs. ❑ Ms. First Name: Last Name: Title: Phone #: Ext: Fax #: Alternate Fax #: Email Address: Address: City: State/Prov: Zip/Postal Code: Country: Will this contact require access to: Transaction History ❑ Report Center ❑ both ❑ ? Account Masking for this contact? ❑ Yes ❑ No Does this contact have a Paymentech Online User ID? ❑Yes ❑No If yes, provide User ID: Revl l/18/10 3 NeWDivIslonSetup/cboo