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CHASE! N E.kyrneentech Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com Phone: (603) 896.6000 , Fax: (603) 696-6713 • Merchant_Services@ChasePaymentech.com SECTION M R15PORT CENTER AND TRANSACTION HISTORY ACCESS FORD 1 . Please be sure to include the information below for additional contact that requires access to Transaction History and/or Paymentech Online Report Center. 2. Report delivery will be web based via Paymentech Online, 3. Please note: You, the merchant, are responsible for advising Chase Paymentech of changes in Paymentech Online contacts. Chase Paymentech assumes no responsibility or liability of any kind for Merchant's failure to advise Chase Paymentech of changes to or elimination of Paymentech Online Users. Please be sure to complete all fields below. Salutation: Check one: ® Mr. ❑ Ms. ❑ Mrs. Name: Robert Lapides Title: EVP Phone #: 781-848-3733 Fax #: 877-256-8330 Address: 35 Braintree Hill Office Park, Suite 100 City: Braintree State/Prov: MA Zip/Postal Code: 02184 Country: USA Email Address: (4o bytes) blapides@invoicecloud.com (username@domaln.com) Does this contact have a Paymentech Online User ID? ❑ Yes ® No If yes, please provide User ID: Does this User require access to: ❑ Reporting ❑ Transaction History ® Both Account Masking ® Yes ❑ No For existing merchants — Is this User replacing an individual with Paymenteoh Online Access? ❑ Yes ❑ No If yes, who? Has this individual left the company? ❑ Yes ❑ No For existing merchants -- Is this User's access to be mirrored like another User Paymentech Online Access? ❑ Yes ❑ No If yes, who? Salutation: Check one: ❑ Mr. ® Ms. ❑ Mrs. Name: Deborah Bowler _ Title: VP of Operations Phone #: 781-848-3733 Fax #: 877-256-8330 Address: 35 Braintree Hill Office Park, Suite 100 City: Braintree State/Prov: MA _ Zip/Postal Code: 02184 Country: USA Email Address: (40 bytes) dbowler@invoicecloud.com (username@domaln.com) Does this contact have a Paymentech Online User ID? ❑ Yes ❑ No If yes, please provide User ID: Does this User require access to: ❑ Reporting ❑ Transaction History ® Both Account Masking ® Yes ❑ No For existing merchants — Is this User replacing an individual with Paymentech Online Access? ❑ Yes ❑ No If yes, who? Has this individual left the company? ❑ Yes ❑ No For existin merchants — Is this User's access to be mirrored like another User Paymentech Online Access? [I Yes (I No If yes, who? Ford ,itiorlal Usors, V1044 suh ad lbro* I, Robert Lapides EVP verify that the (Print Name) (Title)" contact information is accurate, that I have the authority to make such a request and thus it should be used to grant access for these contacts to access Transaction History and/or the Repor Center. tiggnatttee �� A Jr c, ULA *(must be signed by Exe lutive or Financial Contact) Rev11/18110 10 New Division/cboo