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CHASE0.1 Memhent SeWlGiis - 4 NorlwaStern Boulevard, Salem, NI -1 03079-1952 - � wchasepaymentechuorn <br />Phone (603) 898-6000. Fax 1603) 89&8715 - tvlerchant_SeNires@ChasePaymentech.com <br />-SECTION 8- PROCESSING METHOD Lc:ontinqed_ —1 <br />0 6. Will you be using a Point-of-sale terminal (US & Canada only) or Point -of -Sale software? <br />Point of Sales Software: <br />POS/Software Name: Host Capture E] Terminal Capture ❑ <br />Connectivity: Dial [I NetConnect [I (if NetCormect see requirements below) <br />If NetConnect Where is your software hosted/configured? Corporate locationE] or Division local <br />NetConnect Contact Name: Email address: <br />Usarld if existing: Phone: <br />PIN Pad Type and quantity?(for PIN BASE DEBIT Only) Quantity: <br />Is PIN Pad Existing E] or PIN Pad Purchase Needed[] <br />Injection —Will you be using the Chase Paymentech Encryption Key 171 or you do own your own Encryption Key) El <br />Who will be injecting the Encryption Key into your PIN Pad? Please select one below: <br />El Chase Paymentech Solutions El Other Vendor Name: <br />Equipment/Terminals: <br />Will you El Purchase? El Rent? (US Only) <br />El Use existing equipment? El Yes El No <br />If purchase or rent, date needed by: <br />Terminal quantity? Printer quantity? <br />Terminal/Equipment Type: Printer Type. <br />Most Capture El Terminal capture n <br />Connectivity: Dial E] NetConneot E] Wireless EJ (if NetConnect see requirement below) <br />NetConnect Contact Name: Email address <br />Userld if existing: Phone: <br />PIN Pad Type and quantity? (for PIN BASE DEBIT Only) Quantity: <br />Is PIN Pad Existing [] or PIN Pad Purchase NeededD <br />Injection — Will you be using the Chase Paymentech Encryption Key 0 or you do own your own Encryption Key? <br />Who will be injecting the Encryption Key into your PIN Pad? Please select one below: <br />[I Chase Paymentech Solutions El Other Vendor Name: <br />Store Phone #: Terminal Line Phone P. Dial Out Prefix g8,5l: <br />Customer Service Phone # (if different then Store Phone #) <br />Equipment/Kits/imprinters Ship To Address (if differerifthan store Attention to: <br />location) Please ensure a contact will be available to accept shipment: <br />Street Address: <br />City: <br />Ship to contact's phone#: <br />Store Opening Date: <br />Default will be Store Manager <br />State[Prov: Zip/Postal Code: Country: <br />Ship to contact's email: <br />Special Requirements: <br />Do you require a "re -program" kit? (overlay, quick reference guide, etcJ Yes[] NoEl <br />Do you require an Imprinter? [JYes EDNo Type of Imprinter required: With Dater El or Without Dater El <br />Do you require an Imprinter Plate? DYes E]No <br />Do you require a Welcome Kit? (this Includes sales drafts, credit drafts, etc) YesE] NoE] <br />ReVI1118/10 7 Now Divisiontcboo <br />