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f 0.rd OFFICE: REP: Emma Baillie ACH Processing Application I Mial SIC: +PC%!PR CESSINGRY& _- . . =W ;n%'� OZi r, Q ACH Processing Program - (SFTP) Virtual Temenal (a) Martially key data into Virtual Temlinai, Or b Upload comma separated values CS files Into Virtual terminal .<..i ><._ ._. BUS'.INES$:1NE0'RM'A.T(G" _.,... . U:..Fit;.,s ".S..rkMs'`;d +TMS",'dC.ta�.c�,�'1s_=cs`, •_:. eg ameCity of Santa Ana ° 714 540 -9737 Numpens: 1 s" Contact Person DBA BuelneaA Christine Duarte o a0on Re20 Civic Center Plaza ma Aadmmcduarte@santa- ana.org Address: ty Santa Ana state: CA ZIPb2701 IO Number: 956000785 of Empbyees: .,.. , +.=�- - tt,.^-a'R: .. ACH;P. ,FWU '.., _ ,. -. I,,. -i"r 'y" -:" �rr� , I 1 x�.. Corporate Credit or Debit Pre - arranged Payment and Deposits Telephone Initiated Entry Web Initiated Entry ❑ CCD Cre I ❑ PPD Credit ❑ PPD Debit ❑ TEL Debit ❑ WEB Debit Merchant's Average Items /Month #; __— Requested maximum $ /Transaction _$;__,_ -- -- Activity Average Item S__ $ / Day $ Average Returns / Month #: $1 Month $ # Trans / Day #: # Trans I Month #. >, `PWNERS7PARiNERSlDFF {OEftS::. ...., < eta ''.t.:...as"ar'"'`"'akv.�t`i� i)Name(print): Title: Equity/ wners ip: Data of Birth: Drivers License # State: Social Home SBCUrit #: Phone: Home Address: City State: Zip 2) Name (print): Title: quity /Ownership: % Date of Birth: Drivers License # State: Social Home Security #: Phone: Home Address: City State: Zip ?r..n 5 ' r �p—i < � . . Bank #1 Name: Account Number: Phone: Bank #2 Name: Account Number: Phone: .,.. �. "6UEINESStPRSiE {$u,a ,.:.., Type of Ownership: ❑ Sole Proprietor ® Partnership B Corporation (State of Incorp: _ _) ® Other Government Number of Years in Business 143 Length of Current Ownership: 143 Other currently /previously awned businesses: / Prior Bankruptcy? ® Do you currently accept Visa Yes ®No Dale Discharged: MasterCard / Discover® Network? ®Yes [3 No (If yes, submit 3 most current statements) Currently Processing with EFT ?: ® Yes® No (if yes, name of current processor): Methods of Marketing: Detailed Description of Business License - Products /Services Sold, "a'...=;: ;REP100lEpur,E` Item Fee: $ 0.25 and 025 % each Rem Monthly Fee: $ 5.00 Setup Fee: $ 0.00 Monthly Minimum: $ 10.00 Inquiry Fee: $5.00 Gateway Fee: $ 0'00 Over Monthly Limit Surcharge: $0.10+0.1% File Load Fee: $0.50 / Batch Overdraft Fee: $25.00 each occurrence Returned Item Fee: $ 3'50 Late Returned Item Fee: $ 3'50 (Each rejected or corrected Item) Excessive Return >l % $1a .00 / Rem Excessive Late Return / Item .0#70 1`A0% " �Fee: < AUI HORIZ-AT10: NAT0CREDI N DF;eDeE: �$i3IT A C - 77777 T CLIENTherebyallhorL aCardFlmd, In accondancawin dis Data Fmcessing and Payment Collection Agreement, to iinflate debt and credit entries 0 CLIENT'S business cheddrg account as Indicated on tre enclosed voted dwA This authority is to roman inIII taros aril affect utllil (a) CardFlex has recaked Milan notificalim from CLIENT of its teninadon in suds manrrer ae to afford CardFlex reasonable oppotrity to act on it and (b) all odigatons of CLIENT to CarrFlexthat haw ansen under sisAgreement have been paid in full, Irdudrg, but notlIni to, show odigatiam described In paragraph 7 chips Ageement. THs authorization elAends to such entries in said account concerning lease, rental or urdrses agreeni for software ani accompanying Kul mart INVESTIGATIVE CONSUMER REPORT: An investigative a Consumer Repon will de made In connection with the application. Applicant authorizes CardFlax aany creck bureau a any cr iit reporting agency employed by Cari OR ANY AGENTS OF CardiFlex to twesfigale the references Oven aarty other statements or data dhttined from CLIENT, or ary of the underal pdrdpals. WARRANTY: Each of the amnera ilkers above listed have ra�exad application and warrants that ell information is hue and correct Each undersigned comer /uroar ofCIJ ENT ragworts and warrant drat he has read and rndersMndste Data Processing and Payrrent Calleotian t(i ng and wfdherd Initiation, the PrMSms N paragraph 7. Incorporated herein by reference). Owner/Officer Signature #I: Title: Executive Dire Ctor FMSA Date: 1 15 I Ownsd0fficer 81 gnature #2:X Title: Interim Citj Manager Dai 1W1 �F(2R_A(�EORRPRl1TION5;` =,Oro[ urate'ResOlutl4n�,sti- ra.,:k"z +�`�,: e'• " -' The indicated oKce identified above has the autho'zatien to execute the Merchant ProcessI g Agreement with Bank and CFS on behalf 0 the here wMln named corporator. Secretary of the Board: X llM�. r �'� .y;,� Date;j .r# O is CARDFUR Inc. ACCEPTANCE Application Approved BY: Title: _.. __. Date_ / / Rev. 062012