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<br />Payment£ ~
<br />Resources.,
<br />International
<br />620 Newport Cenle' D., . 150
<br />Newccrt Beach, CA 92660
<br />
<br />Merchant Application
<br />and Agreement
<br />
<br />BE
<br />REP:
<br />MID:
<br />
<br />~
<br />
<br /> BUSINESS INFORMATION
<br />eg' ,me: City of Santa Ana hone", 714.647.5355 ""714.647.5304
<br />I~~~n~s~":s) talement M" ,no ,dd,ess:
<br />'¡::::':~;/"Ie 20 Civic Center Plaza, M13 ,Iy: late. Lip:
<br />'Iy: Santa Ana "lale:CA Zip: 92702 ede,,1 ax 'u Nombe" 95.60000785
<br />ontact e"son: NOm,.. 0' Ematt:
<br /> Locations:
<br /> OWN E RSiP ARTN ERSIO F FIC ERS
<br />1) N,me (pnnt): Rod R. Coloma ,tte: Executive Director <,oily/wne"hlp. 0/,
<br />ale 0' "'rth: Soc,at Home
<br /> Seconly": PhOne:
<br />Home dooess: Lity: ot"e. LOp
<br />IL) "me (pnnl): Christine C. Calderon ClUe: Treasury Manager <,wly/Uwne" 'p. 0/,
<br />,te of B'rth: Soc,,1 Home
<br /> Sew.ity". Phone
<br />Home Add.ess: Lfty: .tale. L,p
<br /> MERCHANT PROFILE SECTION VISAIMASTERCARD INFORMATION
<br />Type of Dwne"sh,p. MERCHANT TYPE VtSAIMaste.Ca. Sales Pmfile
<br />D Sole Pmp.ieloo D Partne"hip D Coopo"tion IZI Othe. I D Retail Dottet ~:'~~d,:a'ds ISO 0/,
<br />Nombe. of Ye"s in B"ine,,:c==J Length d Co"enl Dwne"hip: c::::J 0 Restao"nUFood 'MustTDtal100%
<br />Olhe' coITenllylp,evio"ly 0 MaiVTelephone Orne. Only Crodi/ Ca,d' [20 0/,
<br />owned b"inesses Keyed'
<br />P.io, e,nk<oplcy? 0 Yes D Nc D"e Disch"ged: 0 Home B"iness, T"de Fai"
<br />Do you co"enlly accept VtSAIMaste.C"d? IZ!Yes (tt yes, yoo most subm,1 3 mosl co"enl 0 Dolside Sates/Se~""', Othe" Etc
<br />DNo stalements)
<br />Do you wish 10 ,ccepl: EeT"".ds? DYes DebiUATM "",ds g~~s (,oooi,es a pin p'd) Dtnlemet
<br /> I2INo
<br />Se"onat B"ine,,? DYes [Z No ttye" tist monlhs: 0 Lodging Meochanl Receives tmp,inl
<br /> On Keyed T"nsactions. DYe, DNo
<br />Has Ihis business 00 any associaled p,incipal been le'minaled as a VtSAIMaste..ca.d Meochan!? DYes [Z No
<br />Melhods of Ma"'eting: D Newspape.lMagazin" D tntemel D Tetevis:ion/Radio D Di,ecl Mail, Booch"e & C"alogs 0 Telema"'eting Sares
<br />Detalfed Description 01
<br />Producf,¡Servlce, Sold,
<br />Do you cuITenlly pmce" with ACH? DYe, 121 No Ave"ge ACH item: . -- Ann"t ACH Vo1ume:
<br />tt yes, nom. of co".nl p",c..so<::
<br />... .i.CpMP~ THIS SECTION FOR AU. MERCHANTS PROCESSING WITH 20% OR MORE KEYED VOLUME
<br /> Percentage of monthly volume for: ~, tt Inle'nel ,elated, tt,t web add,.."
<br />Tetephone O,d...: XXXX Malt and!", Fax Dod.,,: XXXXX tnlomel Orn...: XXXXX ,
<br />
<br /> ADDITIONAL SERVICES
<br />D GifULoyatty C"d D AVS Roou",", D Ch.ck Gua"nlee Comp,ny:
<br />.DÑ;;;.Am-;;;;-~ Exp;;;;"A~uni I D Existing AMEX Meoch,nl .. Accounl" ...--.."-.-.-.,,.-,...., '...--.--"'----""""-.
<br />D New Discove, Aceoonl c:J Exts:ting DIs:cov.. Me,chanl Accounl #
<br />D New Din... Clob Accounl D Exis:ting Din... Clob Meochant Accounl'
<br />0 New 0 Existing AcCOonl"
<br /> INTERNET MERCHANT INFORMATION
<br />Exte'nat Gateway (not sopptted by PRII' D 0 PRt Skipj"k
<br />Spon"", Bank: K.y",nk Nationat Assoc.
<br />
<br />EXHIBIT A
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<br />Page I of 3
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<br />REV'MBIOJ
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