Item 26 - Debit and Credit Card Merchant Payment Processing Services

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DocuSign Envelope ID: 69E4955D-23F3-4407-84A7-E75FDC837DB9 Additional Owner/Officer Information Page for Merchant Processing Agreement (If Needed) Note: Complete Owner / Officer Information must be present for all Equity Owners with 25% or greater equity in the business and for any person(s) with authority or control. Spaces 1 - 4 must be completed directly on the Merchant Processing Agreement; all additional owner/officer information may be provided on the Additional Owner/Officer Page as needed. Acceptance of Merchant Application and Terms & Conditions / Merchant Authorization. Your Card Services Agreement is between Global Payments Direct, Inc. ("Global Direct"), the Merchant named above, and the Member named below ("Member"). Member is a member of Visa, USA, Inc. ("Visa") and MasterCard International, Inc. ("MasterCard"); Global Direct is a registered independent sales organization of Visa, a member service provider of MasterCard and a registered acquirer for Discover Financial Services, LLC. ("Discover") and a registered Program Participant of American Express Travel Related Services Company, Inc. ("American Express"). A copy of the Card Services Terms and Conditions, revision number Government Entities 04-22-GPI- WF, has been provided to you. Please sign below to signify that you have received a copy of the Card Services Terms & Conditions and that you agree to all terms and conditions contained therein. If this Merchant Application is accepted for card services, Merchant agrees to comply with the Merchant Application and the Card Services Terms & Conditions as may be modified or amended in the future. If you disagree with any Card Services Terms & Conditions, do not accept service. IF MERCHANT SUBMITS A TRANSACTION TO GLOBAL DIRECT HEREUNDER, MERCHANT WILL BE DEEMED TO HAVE ACCEPTED THE CARD SERVICES TERMS & CONDITIONS. By your signature below on behalf of Merchant, you certify that all information provided in this Merchant Application is true and accurate and you authorize Global Direct, and Global Direct on Member's behalf, to initiate debit entries to Merchant's checking account(s) in accordance with the Card Services Terms and Conditions. In addition, by your signature below on behalf of Merchant you authorize Global Direct and/or Open Edge Payments, LLC. to order a consumer credit report on you, Merchant and each of Merchant's officers, partners, and/or owners, as well as subsequent consumer credit reports, which may be required or used in conjunction with the maintenance, updating, renewal or extension of the services provided hereunder, or in conjunction with reviewing, taking collection action on, or other legitimate purposes associated with the Merchant account. Additional Owners -Complete Owner/Officer Information and for any person(s) with authority or control. An this application. Owner/Officer Name: must be present owner or person with for all Equity Owners with 25% or greater equity in the business control listed, must be the one to accept the agreement at the end of Date of Birth (mm/dd/yyyy): Social Security Number: Home Phone Number: Citizenship: ❑ U.S. ❑ Non-U.S Home Address: City: State: Zip: Years There: ❑ Rent El Own Former Address (If less than 1 year at current address): City: State: Zip: Years There: [:]Rent [:]Own SIGNATURE: x Equity Owned: % Title: Date: Owner/Officer Name: Citizenship: ❑ U.S. ❑ Non-U.S Date of Birth (mm/dd/yyyy): Social Security Number: Home Phone Number: Home Address: City: State: Zip: Years There: ❑ Rent ❑ Own Former Address (If less than 1 year at current address): City: State: Zip: Years There: ❑ Rent ❑ Own SIGNATURE: x Equity Owned: % Title: Date: Owner/Officer Name: Citizenship: ❑ U.S. ❑ Non-U.S Date of Birth (mm/dd/yyyy): Social Security Number: Home Phone Number: Home Address: City: State: Zip: Years There: ❑ Rent El Own Former Address (If less than 1 year at current address): City: State: Zip: Years There: ❑ Rent ❑ Own SIGNATURE: x Equity Owned: % Title: Date: Owner/Officer Name: Citizenship: ❑ U.S. ❑ Non-U.S Date of Birth (mm/dd/yyyy): Social Security Number: Home Phone Number: Home Address: City: State: Zip: Years There: ❑ Rent El Own Former Address (If less than 1 year at current address): City: State: Zip: Years There: [:]Rent [:]Own