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DocuSign Envelope ID: 7749OF52-CF5B-4826-AB2C-2C89947EC063 <br />14221 Dallas Parkway, Dallas, Texas 75254 • 4 Northeastern Blvd, Salem, NH 03079-1952 <br />Sales Phone (603) 896-8324 • Sales Fax (603) 896-8701 <br />www,chase paym e me ch, co m <br />Page 1 of 2 Paylnentceli Contract No, 063576 <br />COMPANY LEGAL NAME: City of Santa Ana TAXPAYER ID 95-6000785 <br />REGISTERED TRADE <br />I <br />NAME YEAR BUSINESS STARTED <br />PHYSICAL STREET ADDRESS: <br />(NO PO BOX OR PAID MAIL BOX) 20 Civic Center Plaza <br />CITY Santa Ana STATE <br />CA <br />ZIP CODE 92701 <br />PRIMARY CONTACT Fra ncisco Gutierrez <br />TELEPHONEN <br />714-647-5200 <br />TYPE OF ENTITY <br />❑ INDIVIDUAL / SOLE PROPRIETOR ❑PARTNERSHIP []CORPORATION ❑LLC* ®OTHER: Government <br />TYPE OF OWNERSHIP: <br />❑ PUBLIC ❑ PRIVATE ❑ NON PROFIT * IF LLC,TAXED AS: ❑DISREGARDED ENTITY []CORPORATION ❑PARTNERSHIP <br />STATE OF FORMATION <br />e, <br />C,4 <br />DATE OF FORMATION (M <br />M/DD/YYYY) <br />1/1/1686 <br />TRADING SYMBOL <br />FISCALYEAR END (MM/DD/YYYY) <br />HAS MERCHANT EVER FILED BANKRUPTCY? <br />[j YES NO IF YES, WHAT CHAPTER? FILING DATE: EMERGENCE BATE: <br />SOCIALSECURITY BIRTHDATE <br />NAME R OR <br />O <br />TAM ID NUMBER DATE OF INCORPORATION <br />STREET ADDRESS <br />TELEPHONE NUMBER <br />CITY <br />STATE <br />ZIP CODE <br />SIGNATURE <br />PERCENT OWNERSHIP <br />SOCIAL SECURITY BIRTHDATE <br />NAME OR <br />ore <br />TAX ID NUMBER DATE OF INCORPORATION <br />STREET ADDRESS <br />TELEPHONE NUMBER L— <br />CITY STATE ZIP CODE <br />SIGNATURE PERCENT OWNERSHIP V. <br />DO YOU HAVE ANY ADDITIONAL OWNERS (NOT LISTED ABOVE) THAT HAVE 10% OR GREATER OWNERSHIP? <br />❑ YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) ❑ NO <br />s <br />COMPANY PRESIDENT: <br />COMPANY CFO: <br />IS THERE ANYONE NOT LISTED ABOVE WHO HAS THE AUTHORITY TO MAKE FINANCIAL DECISIONS OR CONTROL COMPANY POLICY ON BEHALF OF YOUR BUSINESS? <br />❑ YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) ❑ NO <br />Page 1 of 2 Paylnentceli Contract No, 063576 <br />