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CHASE Co Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com ,. Phone: (603) 896-6000 • Fax: (603) 896-8715 e Merchant _Services@ChasePaymentech,com N DIVISION Please check below if applicable: ® Bill Payment (A Bill Payment transaction is a transaction for an ongoing service/billing cycle that is known and agreed upon in advance by the merchant and cardholder. i.e. Membership or Insurance, etc.) Do you stock product? ❑ Yes ® No Do you provide custom orders at time of sale? ❑ Yes ® No Do you own the product at the time of sale? ® Yes ❑ No Do you drop ship the product? ❑ Yes ® No If yes, what %: _ Are you filling your own merchandise orders? ® Yes ❑ No If no, who is your fulfillment service bureau? Fulfillment Contact: Phone #: SECTION 6: CHARGEBACK CONTACT: (required) IQA (Manager/supervisor— one who assigns work to MCAs) (Required for retailand Discover) MRQA (Manager/supervisor— one who assigns work to MRAs) NOTE: This contact may receive any exception documents that may need to be mailed or faxed, if not participating to Chargeback Management this will be the default contact for Char eback Mailin second contact will not be required) Location: ❑ Merchant ® Submitter ❑ Fulfillment (check one) If Submitter/Fulfillment, Name: ® Mr. ❑ Mrs. ❑ Ms. First Name: John Last Name: Morabito Title: CTO Phone #: 703-825-3525 Ext: Fax #: 877-256-8330 Alternate Fax #: Email Address _Lmorabito@invoicecloud.com Address: 1815 Beulah Rd City: Vienna State/Prov: VA Zip/Postal Code: 22182 Country: USA Will this contact require access to: Transaction History ❑ Report Center ❑ both ® ? Account Masking for this contact? E Yes ❑ NO Does this contact have a Paymentech Online User ID? ❑Yes ®No If yes, provide User ID: CHARGEBACK CONTACT: (required) MCA (Merchant ChargebackAnalyst— one who works the chargebacks) Required for retail and Discover MRA ((Merchant Retrieval Anai st— one who works the retrievals ® Same as above (check here if the MCA/MRA Contact is the same as the IQA/MRQA contact) Location: ❑ Merchant ❑ Submitter ❑ Fulfillment (check one) If Submitter/Fulfillment, Name: ❑ Mr. ❑ Mrs. ❑ Ms. First Name: Last Name: Title: Phone #: Ext: Fax #: Alternate Fax #: Email Address: Address: City: State/Prov: Zip/Postal Code: Country: Will this contact require access to: Transaction History ❑ Report Center ❑ both ❑ ? Account Masking for this contact? ❑ Yes ❑ No Does this contact have a Paymentech Online User ID? ❑Yes []No If yes, provide User ID: Rev11118110 3 NewDivisiOnSetup/c1300