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CHASEMerchant Services - 4 Northeastern Boulevard, Salem. NH 03078-1652 - swvwohasepaymenteclh com <br />Phone (603) 896-6000 - Fav (603) 0F,8715 - Merctiant-,SeNices@ChasePayrnentech.com <br />SECTION 10: REPORT CENTER AND TRANSACTION HISTORY ACCESS FORM <br />1. Please be sure to include the Information below for additional contact that requires access to Transaction <br />History and/or Paymentech Online Report Center. <br />2. Report delivery will be web based via Paymentech Online, <br />3. Please note: You, the merchant, are responsible for advising Chase Paymentech of changes in Paymentech <br />Online contacts. Chase Paymentech assumes no responsibility or liability of any kind for Merchant's failure to <br />advise Chase Paymentech of changes to or elimination Online Users, <br />Please he sure to complete ell fields below, <br />Salutation: Check one: 0 Mr. Elms. El Mrs. <br />Name: Robert LapidesTitle: EVP <br />Phone 781-848-3733 Fax #: 877-256-8330 <br />Address: 36 Braintree Hill Office Park, Suite 100 <br />CRY: Braintree — StatelProv: MA — Zip/Postal Code: 02184 Country: USA— <br />Email Address: (40 bytes) blapides@invoicecloud.com <br />(usernafrie@dornain.com) <br />Does this contact have a Paymentech Online User ID? Yes E9 No If yes, please provide User ID: <br />Does this User require access to: [] Reporting 0 Transaction History Ej Both Account Masking 0 Yes —E] No <br />For existing merchants - Is this User replacing an individual with Paymentech Online Access? El Yes El No <br />If yes, who? Has this individual left the company? n Yes DNo <br />For existing merchants - Is this User's access to be mirrored like another User Paymentech Online Access? <br />0 Yes 0 No <br />If yes, who? <br />Salutation: Check one: 0 Mr. 0 Me, El Mrs, <br />Name: Deborah Bowler Title: VP of Operations <br />Phone #-. 781-848-3733 Fax #: 877-256-8330 <br />Address: 35 Braintree Hill Office Park, Suite 100 <br />City: Braintree — State/Prov: -MA — Zip/PostalCode: 02184 — Country: USA <br />Email Address: (40 bytes) dbowler@invoicecioud.com <br />tusemame@domain cctic <br />Does this contact have a Paymentech Online User ID? El Yes [I No If yes, please provide User ID: <br />Does this User require access to: E] Reporting 0 Transaction History 0 Both Account Masking E �Ea­E]—No <br />For existing merchants - Is this User replacing an individual with Paymentech Online Access? [I Yes 0 No <br />If yes, who? Has this individual left the company? El Yes E]No <br />For existin merchants- Isthis -User's access to be mirrored like another User Paymentech Online Access? <br />0 Yes No <br />If yes, who? <br />For —additional Users, please submlt —additional forms. <br />1, Robert Lapides EVP verify that the <br />(Print Name) (Title)' <br />contact information is accurate, that I have the authority to make such a request and thus it should be used to grant <br />access for these contacts to access Transaction History andlor the eport Center. <br />Signature: A , <br />A -.�k-- <br />*(must be signed by Executive or Financial Contact) <br />POV11118110 In New Divisiorrlcboo <br />