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<br />TRADE <br /> <br />.. Name: <br /> <br />Merchant: City of Santa Ana <br /> <br />REFERENCES <br /> <br />. Name: <br /> <br />~on"cl: <br /> <br />Phone. <br />"none. <br /> <br />~ontact: <br /> <br />BANK: <br />ank N"ne: Bank of America <br /> <br />an, Kout,ng <br />Numbeo: <br /> <br />Con"cl: <br /> <br />~~;:b:~counl 14316-81776 <br />SITE INSPECTION <br /> <br />Phone <br /> <br />The Me"hant: Landlo", Telephone #: <br />(Z] Owns 0 Leases Ihe bu>iness p..mises <br />Me,ch,nl Location: 0 Retait St"e Fwnl 0 Dffice/W"ehou>e 0 Residential <br /> <br />Landt", Name <br /> <br />0 Inleme! <br /> <br />0 Dthe, <br /> <br />Does Ihe ,mounl of in'enlo'Y and me,chandi,. on shet,.s appe" consistent with Iype of buson",? <br /> <br />0 Yes 0 No <br /> <br />I hmby certtfy th,1 t ha,e tnspeeled Ihe business p..mises of the me,ch,nl at this ,dd,ess and Ihts ,"ovey ts cwecl 10 the best of my knowledge, <br /> <br />tnspected by: <br /> <br />Title: <br /> <br />Date: <br /> <br />HARDWARElSOF1WARE <br /> <br />TERMINAL PROGRAM <br /> <br />Te=inal Type: <br />P,inle,O <br /> <br />OTY' - 0 Retait (80% Swiped) <br />0 Restauo,nl (wi tip pwg"m) <br /> <br />0 None <br /> <br />mat Dot Codes <br /> <br />Modet: <br /> <br />Pin Pad 0 <br /> <br />0 MOTQ (AVS Requi,ed) <br /> <br />Model: <br /> <br />0'8" <br />0 "9" <br /> <br />Check Reade' 0 <br /> <br />Model: <br /> <br />0 Puochase C"d <br /> <br />C"d Reade, ¡z¡ Model: 5000 series OCR reader 5133 N01 <br />P.C. Softw"e ø ~~~~~a;nty) Softw"e N,me: IC Verify Version 2.5.01 <br />~~~~~.i.~p;;e;~~:o be multi.user master appi. version 1,02 <br /> <br />0 Lodging <br /> <br />0 Olh.. <br /> <br />Wt,eless P<o,'de" <br /> <br />Paymenl Amount $ Shtp Add,...: <br />via: 0 C,editC"d 0 Check 0 ACHto..""offiœ <br /> <br />Numbe' of tmphnle' Plates Needed DID Ship Wetcome Kit Dnty <br /> <br />0 Me"hant 0 Office <br /> <br />Equipmenl is:O Rep<og"m 0 P<ovided by PRtl Ship 10: <br /> <br />N,me on Acct. <br /> <br />Acct, # <br />0 Lease <br /> <br />E'p.- <br /> <br />Lease Co Phone # <br /> <br />Calt me<chanl f" 0 downtoad 0 "aining Phone # <br /> <br />..,- <br /> <br />Con"ct: <br /> <br />Comments: <br /> <br />Merchant Documentation Requirements: <br /> <br />0 <br />D <br /> <br />Signed Merchant Application and Agreement including Signed Resolution and Signed Personal Guaranty by principals <br /> <br />Photos of location or brochures, business cards or other identifying business infonnation on the Merchant. For an Intemet Business, <br />a printout of the Merchant's web page <br /> <br />Copy of voided Check <br /> <br />All Web Site URLs, Passwords and Domain Names <br /> <br />0 <br />0 <br />0 <br />0 <br />CJ <br />D <br /> <br />Financial statements for Merchants processing over $10 million in annual Merchant sales volume <br />3 months of merchant statements from previous processing <br />Photocopy of drive~s license <br /> <br />Additional setup fonn (ECShop, Gift/Loyalty Card, American Express, Discover) <br /> <br />Page 3 of <br /> <br />REV 1012'" <br />