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0 Discover I Visa I Mastercard Standard Retail I High
<br />Risk Retail Rates
<br />Merchant Chooses to accept the following:
<br />Peritem
<br />DISCNS/MC (Other Cards) Clad Rate:
<br />0.00 V.
<br />VS/MC Discount Rate for Debit Cams
<br />0.00 %
<br />AMEX Discount Rate:
<br />0.00 V.
<br />DISCNS/MC (Other Cards) Olscount Rate: Inti
<br />VS/MC Debit Card Discount Rale: Intx %
<br />AMEX Rate: AZnfi Monthly
<br />DISC/VS/MC Transaction Fee:
<br />0.00 Per Item
<br />DISCNS/MCTransectlon Fee:
<br />Peritem
<br />Nan-Bankcard Transaction Fee:
<br />SCT60 per Item
<br />Non-Bankcand Transaction Fee:
<br />---.0035
<br />$0.04 Peritem
<br />Statement Fee:
<br />$0.00 Monthly
<br />Statement Fee:
<br />$0.00
<br />VIMAS Online Service:
<br />$0.00 MonthlyMonthly
<br />VIMAS Online Service:
<br />$0,00 Monthly
<br />Monthly Minimum:
<br />$0.00 Monthly
<br />Monthly Minimum,
<br />$0.00 Monthly
<br />Annual Fee:
<br />$0.00 per Year
<br />$0,00
<br />Debit Transaction Fee Plus Network Fees:
<br />0.00 per Item
<br />Annual Fee:
<br />per Year
<br />_
<br />Debit Access Fee:
<br />_
<br />$0,00 Per Item
<br />MOTO/Internet Surcharge:
<br />0.00 Per Item
<br />EBT-fanmetton Fee:
<br />$0.00 Per Item
<br />AVE Surcharge:
<br />$0.05 per Item
<br />EBT Statement Fee:
<br />$0,00 Monthly
<br />Batch Fee:
<br />$0.00 per Batch
<br />Batch Fee:
<br />$0.00 per Batch
<br />Manual Imprinter: QTY: 000
<br />__$0_00 One Time
<br />Manuel Imprinter: QTY:0_00
<br />$0,00 ChaTme
<br />Chargeback/ACH Reject Fee:
<br />525.00 Per Item
<br />ChargebackrACH Reject Fee:
<br />$25.00 Per Item
<br />Retrieval Fee:
<br />v;00 Per Item
<br />Retrieval Fee:
<br />$5A0 Per Item
<br />Voice Authorization Fee:
<br />50 B5 Per Cali
<br />VaiceAuthorization Fee:
<br />$0.95 Per Cell
<br />Gateway Access Feet
<br />$0.00 Monthly
<br />Gateway Access Fee:
<br />$0.00 Monthly
<br />$1_00
<br />AVS Surcharge
<br />$000 per Item
<br />Government Compliance Fee:
<br />__- Monthly
<br />Government Compliance Fee:
<br />$0,00 Monthly
<br />TIN Mismatch Fee:
<br />_ $19.95 Unit Validated
<br />TIN Mismatch Fee:
<br />$0,00 Until Validated
<br />Eary'rennum lon Fee:
<br />$495.00 One Time
<br />Early Termination Fee:
<br />$495.00 Grannie
<br />Mlsc Feea. Start M.Nr:
<br />Amount: Terms:
<br />Mise Fees: Start Mohr.
<br />Amount Terms:
<br />41
<br />qi PCI Cannerance
<br />12 PCI ComPllance
<br />$3.95 Monthly
<br />___ $45.eo Annual
<br />_ _
<br />N2 -_- -- ____ ________ _ ________
<br />43-
<br />44
<br />...................... .._.-.-.-.- .....
<br />B4 --- ---------- .______---
<br />1) Il We understand and agree that while my/our discount rale as stated
<br />above will be charged on most electronically authorized payment card transactions that are In batches closed dally, charges up to 5% higher than mydiscount --
<br />rate may apply where additional criteria is not met. Examples where higher
<br />rates apply include but are not limited to are MOTO, keyed in immediate, transactions without AVS, business and
<br />foreign card transactions. 2) Pass-
<br />through Association fees include Visa Acquiring Processing Fee, Visa Risk Handmaiden Fee, Visa Misuse ofAuth Fee, Visa InternaAonal Service Assessment Fee (ISA), Visa Zero Floor Limit
<br />Fee, Visa IntemationalAcquirer Fee,
<br />MC Accgicrer Pro ram Support Fee MC Cross Border Fee, and lire MC Network Access and Brand Usage (NABU) Fee. Please visit the Association's website for further details. Do you use a third party to store or transmit Cardholder
<br />dabs?'oYasf]No Give Include, but limited to facing Loyalty Programs, Electronic Data Capture),
<br />neme)address:(examples not companies, shopping carts,
<br />Please Identify any Software used for storing, thermal or processing Cam Transaction or Authorization requests Car dFlex Gateway
<br />Merchant
<br />10- Benefits Club
<br />❑Yes, I want to participate In the optional Merchant Benefits Club which Includes equipment support and replacement for an additional $14.99 per annunallperipherel per month.
<br />Initials: X
<br />By signing below, I represent that I have read and am authorized to sign and submit this application for the above entity which agrees to be bound by the American Express® Card Acceptance Agreement ("Agreemenl"j, and that all
<br />Information provided herein is true, complete and accurate, I authorize ESA and American Express Travel Related Services Company, Inc, ('American Express") and American Express's agents and Affiliates to verify the lateral
<br />In this application and rel and exchange Information about we personally, including by requesting reports from consumer morning agencies, and disclose such Information to their agents, subservience, Affiliates, and other
<br />paries for any purpose permitted by law. I authorize and direct ESA and American Express and American Express's agents and Affiliates to inform me directly, or through the entity above, of reports about me that they have requested
<br />from consumer reporting agencies. Such Information wall Include the name and address of the agency furnishing the report. I also authorize American Express to use the reports from consumer reporting agencies for marketing and
<br />administrable purposes. I understand that upon American Express's approval of the application, the entity will be provided with the Agreement and materials welcoming It to American Express Card acceptance campaign.
<br />IU Retail -$0.10 Trans Fee +0.30% CNP Downgrade Services GWholesale &All Other -$0.15 Trans Fee
<br />Merchant authorizes Cynergy Data, LLC. ('Processor") at END Harris Bank, N.A., (°Bank') to present Automated Clearing House credits, Automated Clearing House debits, wire transfers, or depository transfer checks to and
<br />from the following account and to and from any other account for which Processor at Bank are authorized to perform such functions under the Merchant Processing Agreement, for the purposes sat forth in the Merchant
<br />Processing Agreement. This authorization extends to such entries in said account concerning lease, rental or purchase agreements for POB terminals andlor accompanying equipment andlor check guarantee fees and amounts
<br />due for supplies and materials. This Automated Clearing House authorization cannot be revoked unit all Merchant obligations under this Agreement are satisfied, and Merchant gives Cynargy Data written notice of revocation.
<br />DDA: ABA Routing:
<br />INVESTIGATIVE CONSUMER REPORT: An investigative or consumer report may be made in Connection with application. MERCHANT authadzes BANK or any of its agents to investigate the references provided or
<br />any other statements or date obtained from MERCHANT, from any of the undersigned individual credit Or financial responsibility You have a right, upon written request, to a complete and accurate disclosure of the nature and
<br />scope of the inVoilmofion requested.
<br />uwrux vary r vu, r ice: An mmrmanon contained in rms appncanon was compreret
<br />in panted terms unless specifically agreed to In wilting by an officer of Pneumatic
<br />within this merchant application, on the reverse side (the Merchant Agreement)
<br />As a primary Inducement to Processor and Bank to enter Into this Agreement, the undersigned
<br />Guarentorfs), by signing this Agreement, jointly and severally, unconditionally and irrevocably, personally
<br />guarantee the Continuing full and faithful performance and payment by Merchant of each of Its duties
<br />and obligations to Processor and Bank under this Agreement or any other agreement currently in affect or
<br />in the future entered into between Merchant or Its principals and Processor or Bank, as such agreements
<br />new exist or are amended from time to time, with or without notice. Guaranlmfs) understands further that
<br />Processor or Bank may proceed directly against Guarantors) without fast exhausung their remedies against
<br />any other person or patty responsible to it or any security held by Processor and Bank or Merchant. This
<br />guarantee add not be discharged or affected by the death of the undersigned, will bind all heirs, administrators,
<br />representatives and assigns and may be enforced by or for the benefit of any successor of Processor and
<br />Bank. Guarantor(s) understand that the inducement to Processor and Bank to enter into this agreement
<br />is consideration for the guaranty, and that this guaranty remains in full force and effect even H the
<br />Guarantors) receive no additional benefit from the guaranty,
<br />AGREED AND ACCEPTED
<br />#1 From Application - Signature Date
<br />X
<br />#2 From Application - Signature Date
<br />of the above
<br />Hants Bank,, N.A., Chicago, IL. By signing below you ere agreeing to the provisions stated
<br />dge receipt of the merchant operating guide. Those provisions must be read before signing.
<br />to execute the MERCHANT Processing Agreement on behalf of the here within named
<br />business. MERCHANT UNDERSTANDS THAT THIS AGREEMENT
<br />SHALL NOT TAKE EFFECT UNTIL MERCHANT HAS BEEN
<br />APPROVED BY BAN AND A MERCHANT NUMBER IS ISSUED.
<br />CitvofSania)Ana
<br />P't Leat ame of etch 1it usiness
<br />X .(..._r I. A
<br />44-
<br />#1 From ApplicationSignatum Date
<br />X
<br />#2 From Application - Signature Date
<br />X
<br />Accepted by Processor Dater
<br />X
<br />Accepted by BMO:Harrs Bank, N.A, Chicago, It. Date:
<br />CardFlex Financial Services is a registered ISO/MSP of BMO Harris Bank, N.A., Chicago, IL. Rev2. 10/01/2011
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