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<br />201405 Merchant Application SBS Pass Through
<br />CONFIDENTIAL
<br />TSYS Merchant Solutions, LLC is a registered went at First National Bjyfk of Omaha, 1620 Dodge Street, Omaha, NE 68197
<br />MARIA D. HWIZAR
<br />CE_RR( OF THE COUNCIL_
<br />AMERICAN EXPRESS
<br />© Existing American Express ESA ESA SE Merchant CAP
<br />New American Express OnePoint Discount % lZiNew American Express ESA Discount % ❑ Monthly Flat (ESA)$
<br />Merchant Name CITY OF SANTA ANA Annual American Express Charge Vol $ Avg Ticket $
<br />Retail: +$0.10 Trans Fee ❑ Restaurant: + $0.05 Tran Fee
<br />Daily Net Pay —ESA only ❑Daily Gross Pay —ESA only
<br />FlMonOdy Gross Pay (+,03 %if$IOOK +) - ESA only
<br />Retail, Restaurant, Travel Agencies & Tour Operators: ❑
<br />0.30% CNP Downgrade
<br />Payment Timing - ESA Only: Q 3 Day ❑ 15 Day ❑ 30 Day
<br />B2B, Travel AgenciesiTour Operators & Services, Fj
<br />Wholesale & All Other: + $0.15 Trans Fee
<br />Inbound Pee: 0.40% on Cross Border Transactions*
<br />Prepaid Gill Card Discount: % + $ per transaction
<br />*Not applicable to Education
<br />By signing the Merchant Transaction Processing Agreement with BANK and TMS, I represent that I have read and am authorized to sign and submit this
<br />application agreeing to be bound by the American Express * Card Acceptance Agreement ( "American Express Agreement "), and that all information provided herein
<br />is true, complete, and accurate. 1 authorize TSYS Merchant Solutions, LLC, and its agents, assigns or affiliates (collectively'7MS ") and American Express Travel
<br />Related Services Company, Inc. ( "AXP ") and AXP's agents and Affiliates to verify the information in this application and receive and exchange
<br />Information about me personally, including by requesting reports from consumer reporting agencies from time to time, and disclose such information to their agent,
<br />subcontractors, Affiliates and other parties for any purpose permitted by law. I authorize and direct TMS and AXP and AXP's agents and Affiliates to
<br />inform me directly, or inform MERCHANT, of reports about me that they have requested from consumer reporting agencies. Such information will include the name
<br />and address of the agency furnishing the report, f also authorize AXP to use the reports on me from consumer reporting agencies for marketing and
<br />administrative purposes. I am able to read and understand the English language. Please read the American Express Privacy Statement at
<br />littp: / /www.americanexpress.com /privacy to learn more about bow American Express protects your privacy and how American Express uses your information. I
<br />understand that I may opt out of marketing communications by visiting this website or contacting American Express at 1 -(800 )-528 -5200, I understand that upon
<br />AXP's approval of the application, the MERCHANT agrees to abide by the American Express Agreement and will be sent materials welcoming it, either to
<br />AXP's program for TMS to perfatm services for AXP or to AXP's standard Card acceptance program which has different servicing terms (e.g. different speeds of
<br />pay), I understand drat if MERCHANT dues not qualify for TMS's servicing program that the entity may be enrolled in AXP's standard Card acceptance program,
<br />and MERCHANT may terminate the American Express Agreement. By accepting the American Express Card for the purchase of goods and /or services, or
<br />otherwise indicating its intention to be bound, MERCHANT agrees to be bound by the American Express Agreement. I understand that TMS and BANK are not
<br />parties to the American Express Agreement.
<br />PERSONAL GUARANTY
<br />THIS general, absolute, and unconditional continuing Guaranty ( "GUARANTY ") by the undersigned (collectively "GUARANTOR" or "my" or T' or "me "), is for
<br />the benefit of TSYS Merchant Solutions, LLC and /or First National Bank of Omaha ( "Collectively TMS "). For value received, and in consideration of the mutual
<br />undertakings contained in the Merchant Transaction Processing Agreement and allied agreements ( "AGREEMENT ") between TMS and ( "MERCHANT ") as set
<br />forth below, I absolutely and unconditionally guarantee the fill performance of all MERCHANT's obligations to TMS, togetherwith all costs, expenses, and attor-
<br />neys' fees incurred by TMS in connection with any actions, inactions, or defaults of MERCHANT. I waive any right to require TMS to proceed against other entities
<br />or MERCHANT. There are no conditions attached to the enforcement of this GUARANTY, I authorize TMS, its agents or assigns to make from time to time any
<br />personal creditor other inquiries and agree to provide, at TMS's request, financial statements and /or tax returns. I agree that this GUARANTY shall be governed
<br />and construed in accordance with the laws at the state at Nebraska, and that tire courts of the state of Nebraska shall have and be vested with personal jurisdiction
<br />over me. This is a continuing GUARANTY and shall remain in effect until one hundred eighty (180) days after receipt by TMS of written notice by me terminating
<br />or modifying the same. The termination of the AGREEMENT or GUARANTY shall not release me from liability with respect to any obligations incurred before the
<br />effective date of termination. No termination of this GUARANTY shall be effected by any change in my legal status or any change in the relationship between MER-
<br />CHANT and me. This GUARANTY shall bind and inure to the benefit of the personal representatives, heirs, administrators, successors and assigns of GUARAN-
<br />TOR and TMS.
<br />PERSONAL GUARANTOR: (Signature -No Titles) Print Name: (No Titles)
<br />MERCHANT: (Business Legal Name) CITY OF SANTA ANA Social Security Number:
<br />Home Address: Home Phone: Work Phone:
<br />AGREEMENT ACCEPTANCE
<br />By their execution below the undersigned parties agree to abide by the Merchant Transaction Processing Agreement (the "AGREEMENT") The AGREEMENT
<br />consists of the Merchant Application and the Terms and Conditions (a separate attachment hereto), and MERCHANT acknowledges it has received and read the
<br />Terms and Conditions at the time of signing, MERCHANT warrants that the information provided on the Merchant Application is complete and accurate. MER-
<br />CHANT authorizes TMS and /or BANK to provide a copy of this Merchant Application to any third party for the services requested. MERCHANT, and its signing
<br />officer /owner /partner, authorize TMS and /or BANE, or its agents or assigns, to make from time to time, any business and personal credit and other inquiries. If ap-
<br />plicable, MERCHANT agrees by its signature below to [he Equipment Agreement and /or the Card Compromise Assistance Plan Agreement In witness whereof the
<br />part ies hereto have caused this AGREEMENT to be executed by their duly authorized representatives effective on the date signed or approved by BANK.
<br />Principal's Name (Please Print):
<br />Title: CITY MANAN
<br />Equity Ownership ( %)
<br />}tome Phone Na:
<br />Date of Birth:
<br />Principal's See Sec No:
<br />0
<br />(714) 647 -5440
<br />999 -99 -9999
<br />Principal's Home Address:
<br />City:
<br />State:
<br />Zip:
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA
<br />CA
<br />Title:
<br />92701
<br />MERCHANNT(j, CIPAL/ FFICER/ NER)
<br />Name (Please Print):
<br />Date:
<br />Signature: CC
<br />I
<br />TSYS Merchant Solutions, LLC
<br />Name:
<br />Title:
<br />Date:
<br />( "TMS ") Signature:
<br />ArIE,
<br />First National Bank of Omaha
<br />m
<br />( "BANK ") Signare:
<br />.Rte: (�
<br />"���&
<br />Title:
<br />Date:
<br />TSYS Merchant Solutions, LLC is a registered went at First National Bjyfk of Omaha, 1620 Dodge Street, Omaha, NE 68197
<br />MARIA D. HWIZAR
<br />CE_RR( OF THE COUNCIL_
<br />
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