FIRST NATIONAL BANK OF OMAHA/TSYS MERCHANT SOLUTIONS, LLC 2 -2014

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201310 Merchant Application SBS Pass Through CONFIDENTIAL Sales Professional Verification By the signature below, the Sales to essional verifies that that the information stated In this Agreement is correct to the best of his/her knowledge and ism represented to himAter by MERCHANT. Sales Professi alst amre: Sales Professional Name Printed: Bret Johnson Sales Organization: Application Date: Physical Site Inspection Conducted By Sales TSYS Merchant s 5/29/14 Professional Yes Q No CCAP Opt Out Note: MERCHANT may only opt out if MERCHANT validates PCI Compliance with TMS veodorwithin 75 days ofsigning. If at any time MERCHANT is not vali. dated for compliance, MERCHANT will be automatically enrolled In CCAP until such time that MERCHANT restores validation, at which point MERCHANT will again be opted out. MERCHANT declines to participate In the Card Compromise Assistance Plan ("CCAP"), MERCHANT understands that under the terms of the AGREEMENT, MERCHANT is responsible for all expenses, fines, assessments, and penalties that arise in the event that a data breach is suspected or occurs at one or more of MERCHANTS locations. Further, MERCHANT understands and agrees that CCAP assistance will not be available to help pay any of the above mentioned expenses, fines, assessments, or penalties in the event of a suspected or actual data breach at one or more of MERCHANT's locations. MERCHANT acknowledges that despite opting out of CCAP, MERCHANT will still be assessed a PCI Validation Fee. This program is not being offered by BANK. BANK has no responsibility or liability under this program. Merchant Name: L /nom,,, Authori(zed . . �G / 1 /� `�• 1 Title: Date: 5/29/14 Please attach voided check here. TSYS Merchant Solutions, LLC is a registered agent of R St National Bank of Omaha, 1620 Dodge Street, Omaha, NE 68197 800 -853 -9586 4 of 4