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CHASE Merchant Services - 4 Northeastern Eloulevmd, Salem, NH 03079-1952 - mvw Chasepaymemeehicom <br />Phone. (603) 896-6000 - Fax: (603) 896-8715 - MerChant—Services@Cl)asePaymentech.coni <br />SECTION 4: TRANSACTION <br />Please check below if applicable: <br />Z Bill Payment (A Bill Payment transaction is a transaction for an ongoing serviceAdling cycle that is known and agreed upon in <br />advance by the merchant and cardhoilderr. i.e. Membership orlosurance, etc) <br />Do you stock product? E3 Yes M No Do you provide custom orders at time of sale? <br />Do you own the product at the time of sale? Z Yes n- No <br />Do you drop ship the product? [] Yes 0 No If yes, what %: <br />Are you filling your own merchandise orders? Z Yes 0 No <br />If no, who is your fulfillment service bureau? <br />Fulfillment Contact: Phone #: <br />OYes N No <br />SECTION 6: CHARGEBACK CONTACT: (required) 10A (Managarrialkeetvisor- one who assigns work to MCAs) <br />(Required ferreted and Discover) MRQA (Managerlsupervisor-one who assigns work to MRAs) <br />NOTE: This contact may receive any exception documents that may need to be mailed or faxed, if not participating in Chargeback <br />Manaqement this will be the de <br />Location: [I Merchant 0 Submitter D Fulfillment (check one) If Submitter/Fulfillment, Name: <br />Z Mr. El Mrs. El Me, First Name: John Last Name: Morabito <br />Title: CTO Phone M 703-825-3525 Ext: <br />Fax 877-256-8330 Alternate Fax 4; <br />Email Address: -LaLabita(cilinvoicacioud.com <br />Address: 1815 Beulah Rd <br />City: Vienna .— State/Prov: VA Zip/Postal Code: 22182 Country: USA <br />Will this contact require access to: Transaction History [I Report Center ff both N ? <br />Account Masking for this contact? 0 Yes [] NO <br />Does this contact have a Paymentech Online User ID? []Yes ®No If yes, provide User ID: <br />CHARGESACK CONTACT: (required) MCA (Merchant Chargeback Analyst- one who works the chargeback's) <br />Rs utrad ler ratarf and Discover) MRA ((Merchant Retrieval Ana ivst - one who - ' " - -'-! - -'-' <br />Same as above (check here if the MCA/MRA Contact is the same as the IQAIMRQA contact) <br />Location: 0 Merchant 0 Submitter El I'Llifillment (check one) If Submitter/Fulfillment, Name: <br />El Mr. [I Mrs. D Ms. First Name: Last Name: <br />Title: Phone #: Ext: <br />Fax #. Alternate Fax #: <br />Email Address. <br />Address: <br />City: State/Prov: Zip/Postal Code: Country: <br />Will this contact require access to: Transaction History [j Report Center 0 both El ? <br />Account Masking for this contact? 0 Yes [I No <br />Does this contact have a Paymentech Online User ID? E]Yes []No If yes, provide User 10: <br />Revi 1118110 3 NeWD1viS1m1Setup1cboia <br />