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Q CC?A /Tern ?ei, ? C3 ? <br />Ftg _ 7 2013 <br />Principal: Associate: 002 Chain:001 MID#: <br />DDA# MCC Code: 7523 <br />N-2013-014 <br />MERCHANT TRANSACTION PROCESSING AGREEMENT - MERCHANT APPLICATION <br />2012 10 Merchant Application SBS Pass Through CONFIDENTIAL <br />Bm ot <br />City of Santa Ana City of Santa Ana <br />Location Street Address: (No P.O. Boxes) City: State: Zip: <br />20 Civic Center Plaza M-13 Santa Ana CA 92701 <br />Contact Name: Phone: Fax: Email: <br />Minerva (714) 647-5440 MMancha@santa-ana.org <br />Mailing/Billing Address: (If different from Location) City: =State:Zip: <br />Phon <br />e: <br />20 Civic Center Plaza M-13 Santa Ana 01 (714) 647-5440 <br />BUSINESS PROFILE AND ASSUNIP'l-IONS <br /># of Locations: Fed. Tax ID: Annual Visa/MasterCard/Discover Location Volume ($): Business Open Date: <br />1 956000785 Volume ($): 15,000.00 15,000.00 <br />Average Ticket ($): Highest Ticket ($): Avg. monthly Vol. ($): Length of Ownership: Visa/MasterCard/Discover ?Yes <br />1.00 4.00 1,250.00 0 Yr 0 Mo Currently Accepted? ? No <br /># of Employees: Ownership Type: % of Goods/Services Cash and Cary: 100 <br />0 Government <br />Type of Business: Pricing Method: Retail Type of Goods/Services sold:(Please include a copy ofyour retum/refund policy) <br />Retail Pass Thru *See Attached Amendment parking <br />RXious Processor: (Please Include copy of statements) Business Website: www.santa-ana.org <br />Card Present 100 % + Card Not Present % = TOTAL: 100% Sales to Consumer 95 %+ Business 5 % = TOTAL: 100% <br />If CNP Choose one: Card Swipe 100 a/o + Imprint 0 %= TOTAL Card Present % <br />Application Type: Addl. Location LOC/Old MID: Dun & Bradstreet #: (If available) Have you or your business ever declared <br />Never had bankcards 0 bankruptcy? [:1 Yes m No <br />Do you use any third party fulfillment houses? ? Yes ® No Do you work with an third parties or software vendors who have access to <br />an <br />If Yes, please provide a contact list of all third party fulfillment houses. cardholder data? <br />Yes ® No <br /> If yes, please provide a contact list of all third parties and software vendors who <br /> have access to cardholder data. <br />When is cardholder billed for goods/services? F] On Order ?On Shipment Average number of days between order and shipment? 0 <br />Expected date of first transaction? Do you operate as a Seasonal Merchant? ? Yes 0 No <br />If seasonal, indicate operating months: ? Jan ? Feb ? Mar ? Apr ? May ? Jun ? Jul ? Aug ? Sep ? Oct ? Nov ? Dec <br />Bank Reference Name: Contact: Phone: Account Number: <br />JP Morgan Chase Robert Donahue (949) 471-9869 935309500 <br />Trade/Supplier 1 Name: Contact: Phone: Account Number: <br />Trade/Supplier 2 Name: Contact: Phone: Account Number: <br />MEMBER BANK (ACQUIRER) IMPORTANT MEMBER BANK (ACQUIRER) RESPONSIBILITIES) IMPORTANT MERCHANT RESPONSIBILITIES <br />INFORMATION <br />1. A Visa Member is the only entity approved to extend acceptance of 1. Ensure compliance with cardholder data security and <br />First National Bank of Omaha Visa products directly to a Merchant storage requirements. <br />1620 Dodge Street 2. A Visa Member is responsible for educating Merchants on pertinent 2. Maintain fraud and chargebacks below thresholds. <br />Omaha, NE 68197 Visa Operating Regulations with which Merchants must comply 3. Review and understand the terms of the Merchant <br />800-853-9586 3. The Visa Member is responsible for and must provide settlement Agreement. <br />funds to the Merchant 4. Comply with Visa Operating Regulations. <br />4. The Visa Member is responsible for all funds held in reserve that are <br />derived from settlement. <br />The responsibilities listed above do not supersede the terms of the Merchant Agreement and are provided to ensure the Merchant understands some important <br />obligations of each party and that the Visa Member (Acquirer) is the ultimate authority should the Merchant <br /> <br />ve any problems. <br />ll? <br />Merchant Name: <br />City of Santa Ana Authorized Signatur . <br /> X <br />Address: 20 Civic Center Plaza M-13 Print Name: <br />Santa Ana CA 92701 C, Ir- ? LJ/'gS <br /> <br />TSYS Merchant Solutions, LLC is a registered agent of First National Bank of Omaha, 1620 Dodge Street, Omaha, NE 68197 800-853-9586 <br />1 of4