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WNAYAX Attending to the Unattended Schedule 1, FEE AGREEMENT FORM Contact Information Please fill in all relevant information below, and let us know of any changes to your contact information in the future. Company Name: City of Santa Ana Customer # (internal use): SHIPTO Contact Name: Maria Castro Address: 26 Civic Center Plaza, M-75 City: Santa Ana State: CA Zip Code: 1 92701 Phone Number: 714.647.5269 Fax Number: 714.647.5291 Email: mcastro5@santa-ana.org BILL TO (if different) Contact Name: Same as above Address: City: State: Zip Code: Phone Number: Fax Number: Email: **Type of Product/Service Being Sold From Your Machine: Printing Service Fees and Terms (NAYAX TO FILL OUT ONLY) Payment Terms (if reimbursed by Nayax)**: ® Offset/NET30 ❑ Offset/ CC Reimbursement Processing Fee (if applicable): 5.95 Activation Fee (per device): $ 1) Billing Plan: Cashless Only-TBS Monthly Fee (per device): $8.95 . Payment Term descriptions for customers not reimbursed by Nayax: Net30- all invoices (for hardware, activation fees and monthly service fees) are due within 30 days of receipt by check or ErT; CC- all invoices (for hardware, activation fees and monthly service fees) are automatically paid by credit card, kept on file, on date of invoice (credit card service fee may apply) "- Payment Term descriptions for customers reimbursed weekly by Nayax (must also complete the attached Schedule2- Direct Deposit Agreement Form and include a voided check): Offset/Net30- activation and monthly service fee invoices are automatically offset from weekly reimbursements once a month and all hardware invoices are due within 30 days of receipt by check or EFT; Offset/CC- activation and monthly service fee invoices are Nayax I Executive Plaza 1, 11350 McCormick Rd, Ste 1004, Hunt Valley MD, 21031 1 410-666-3800 1 us(&nayax.com I