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CHASE 0,` <br />Merchant Services . 4 Northeastern Boulevard, Salam, NH 03079-1952 • www.chasepaymenteoh.oom <br />Pa <br />ym Phone: (003) 896.8000 • Fax: (603) 896.8715 * Merchant_Services@ChasePaymentech.com entech <br />Section G: FINAL DESTINATION BANK <br />Account Whsre Your Funds are De osited <br />C1 Swift Code: (8 to 11 bytes) <br />C2 Sort Code: (Required in Great Britain Only) <br />C3 IRAN/Bank Account# <br />Company Name: (As appears on Bank account) <br />Financial Institution Name: <br />City: State/Province: Postal Code: Country: <br />Special Wire Instructions: (60 bytes) <br />Section D. INTBRMEDIARYICLBARING BANK ACCGIUNT CNFOaMATIoN, <br />-Note: For paposits goingthrough J.P. Mar on C ase in Lpn n lritermsdia is nat,re ulred.:'Com IeteSoction "C'. only <br />01 <br />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 8:; Sign oture <br />"On behalf of City of Santa Ana I, Francisco GutictTez <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 />_kw Y� i Finance Director <br />\� t2''— <br />Authorized Signature* 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 />-------------- <br />ATTACH VIDE® CHECK HERE <br />-._.- ------------------------------- ------------ --------------------- ----------------------- <br />Rav11/18/10 9 New Divlslon/cboo <br />