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CHASE�' " <br />7rr Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • vwdw.chasepaymentech.com <br />Rayrnentech <br />Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com <br />Section C: FINAL DESTINATION BAND <br />Account Where Your Funds are De osited <br />C1 Swift Code: (8 to 11 bytes) <br />C2 Sort Code: (Required in Great Britain Only) <br />C3 IBAN/Bank Account# <br />Company Name: (As appears on Bank account) <br />Financial Institution Name: <br />City: State/Province: Postal Code: Country: <br />Special Wire Instructions: (60 bytes) <br />Section D. INTERMEDIARY/CLEARING BANK ACCOUNT INFORMATION <br />Note: For ]ntl.Deposits going through J.F. morgan Chase in London Intermadiaryis not required. Complete Section "C'. only <br />01 <br />Swift Code: (8 to 11 bytes) <br />D2 Sort Code: (Required in Great Britain Only) <br />D3 Wire Transfer: (USA Only) <br />(Routing #) <br />D4 Financial Institution Name: <br />City: State/Province: Postal Code/Zip: <br />Country: <br />Special Wire Instructions: (60 bytes) <br />Section E: Signature <br />"On behalf of City of Santa Ana I, Francisco Gutierrez <br />represent and warrant <br />(Merchant Legal Name) (Print Name) <br />that I have the authority to add banking information and I verify that the above banking information is accurate and should be used to <br />transfer funds accordingly." <br />tx®mz! c n �\- - Finance Director <br />Authorized Signature* Title <br />Date <br />(*Must be signed by Executive or Financial Contact) <br />Note: in order to process this request, please attach an original voided check (starter check or bank <br />statements not applicable) or a bank letter of verification. <br />------------------------------------------------------------------------------------------------------------- <br />ATTACH VOIDED CHECK HERE <br />----------------------------------------------------------------------------------------------------------' <br />Rev11/18/10 9 New Division/cboo <br />