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Merchant Services • 4 Nonheastern Boulevard, Salem, NH 03079-1952 « cvww.ehasepaymenoch.com a <br />Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com <br />C1 I 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: <br />Special Wire Instructions: (60 bytes) <br />Postal Code: Country: <br />Section D; INTERMEDIARY/CLEARING BANK ACCOUNT INFORMATION <br />Note: Por#nel Deposits going throd9h J.P. Morgan Chase in Eondon, lMermedfar,�r is not required. Come fete Section " only. <br />D1 Swift Code: (8 to 11 bytes)�— <br />_ <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 1, 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 />- Director of Finance <br />3131/2016 <br />:�4)c N <br />A-6tFibrized Signature" Title <br />Date <br />(-Must be signed by Executive or Financiat Contact) <br />Note: In order to process this recluiestt please attach an original voided check (starter check or bank <br />statements not applicable) or a bank letter of verification. <br />Rev1l/18110 9 Naw Division/cboo <br />