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,NAYfilAXnded <br />DIRECT DEPOSIT (ACH) AGREEMENT FORM <br />Authorization Agreement <br />I (BELOW NAME AND SIGNATURE) HEREBY AUTHORIZE NAYAX AND ITS DESIGNATED FINANCIAL AGENTS TO INITIATE <br />ELECTRONIC FUNDS TRANSFER OF PAYMENTS AS GOVERNED BY THE (NACHA) RULES. THE AUTHORIZATION OF DIRECT <br />CREDIT (DEPOSITS) OR DEBIT (WITHDRAWALS) IS TO REMAIN IN EFFECT UNTIL NAYAX RECEIVES 10-DAY WRITTEN <br />NOTIFICATION OF TERMINATION FROM AN OFFICIAL AGENT OF YOUR COMPANY. ANY CHANGES TO THE <br />INFORMATION PROVIDED BELOW MUST BE SUBMITTED BY AN OFFICIAL AGENT OF YOUR COMPANY AND BE <br />PROVIDED ON AN UPDATED AND SIGNED SCHEDULE 2 "DIRECT DEPOSIT (ACH) FORM". AVOIDED CHECK NEEDS TO <br />ACCOMPANY THIS FORM. PLEASE EMAIL THIS SIGNED AND COMPLETED FORM AND VOIDED CHECK TO: <br />orders@tbsit360.com <br />Company Information <br />Company Name: <br />City of Santa Ana <br />Customer # (internal use): <br />Finance Contact Name: <br />Alejandra Gutierrez, Treasury & Customer Services Manager <br />Address: <br />20 Civic Center Plaza <br />City: <br />Santa Ana <br />State: <br />CA <br />zip Code: <br />92701 <br />Phone Number: <br />714-647-5497 <br />Fax Number: <br />Email to send reimbursement <br />statements (up to 5 emails): <br />TSD@santa-ana.org; mcastro5@santa-ana.org; ddario@santa- <br />ana.or <br />Bank information <br />Name of Financial Institution: <br />JP Morgan Chase & Co. N.A. <br />Name on Account: <br />City of Santa Ana <br />Routing Number (9 digits): <br />322271627 (ACH) <br />Account Number: <br />935309500 <br />Account Type: <br />✓❑ Checking <br />BY PLACING MY SIGNATURE BELOW, I HEREBY DECLARE AND REPRESENT TO NAYAX THAT I AM AUTHORIZED AND <br />EMPOWERED TO BIND MY COMPANY AND ACCEPT THE BINDING TERMS AND CONDITIONS ON MY BEHALF OF MY <br />COMPANY, LISTED ABOVE. <br />l4f1w �uatL AWIk�_� NUnl y �C'fIN�7_ GiTY M�N�6�2 <br />SIGNATURE PRINTED NAME DATE TITLE <br />Nayax I Executive Plaza 1, 11350 McCormick Rd, Ste 1004, Hunt Valley MD, 21031 1 410-666-3800 1 usOnavax.com <br />