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2012 10 Merchant Application SBS Pass Through <br />CONFIDENTIAL <br /> <br />VISA/MC/DISCOVER <br />Pass through pricing: 0.0000 % DISCOUNT on SALES + $ 0.0000 per item on gross items (SALES plus Credits) <br />Merchant Setup $ 0.00 per MID Authorizations $0.0350 per V/MC/Disc/OnePoint Auth <br /> "or" <br />Monthly Maintenance $ 0.00 per MID Excessive Electronic $ per V/MC/Disc Auth over 100% <br /> Authorizations of SALES & per OnePoint Auth <br />Minimum Discount Billing $ per month/MID Non V/MC/Disc/OnePoint Authorizations $ 0.0350 each <br />Chargebacks $ 5.00 each Voice Authorizations $ 0.6500 each <br />Retrievals $ 5.00 each Voice AVS $ 1.99 each <br />Batch Capture $ 0.00 each Paper Statement ? Yes EINo $ 9.95 per month/MID <br />Insufficient Funds Fee $35 per unsuccessful debit of Wireless Monthly $ per device <br />DESIGNATED Account Wireless Set Up $ per device <br />OTHER $ Annual Seasonal $ per MID <br />OTHER $ Regulatory and Compliance $ 1.00 per month/MID <br />ATM/DEBIT ? Yes ?No PCI VALIDATION <br />Setup $ per MID PCI Validation $ 45.00 per year /MID OR $ 6.50 per month/MID <br />Transactions $ each PCI Non-validation: $ per month/MID if MERCHANT is not validated for compliance with <br />Monthly per MID $ TMS's vendor, beginning 75 days after signing. <br />Network Pass thru Interchange <br />Card Compromise Assistance Plan (CCAP) <br />CCAP Fee (PCI Validated): $ 7.95 per month/MID, if MERCHANT is validated for PCI Compliance with TMS's vendor. <br />CCAP Fee (PCI Non-Validated) : $ 29.95 per month/MID, if MERCHANT is not validated for PCI Compliance with TMS's vendor, beginning 75 days after <br />signing. This program is not being offered by Bank. Bank has no responsibility or liability under this program. <br />Account Closure Fee: If the AGREEMENT is terminated early during the INITIAL TERM or any RENEWAL TERM for any reason other than set out in para- <br />graph 5.1, 5.2A, or 5.2.B, then MERCHANT agrees to pay TMS an account closure fee ("ACCOUNT CLOSURE FEE") in accordance with the following $399 <br />per MID during the first 12 months of the INITIAL TERM; $299 per MID during the second 12 months of the INITIAL TERM; $199 per MID during the third <br />12 months of the INITIAL TERM; $149 per MID during any RENEWAL TERM. MERCHANT agrees that the ACCOUNT CLOSURE FEE shall also be due to <br />TMS in accordance with this schedule if MERCHANT discontinues submitting SALES for processing during the INITIAL TERM or any RENEWAL TERM of <br />the AGREEMENT. MERCHANT agrees that this fee is a not a penalty, but rather a reasonable estimation of the actual damages TMS would suffer if TMS were <br />to fail to receive the processing business for the then current term. Paragraph references and capitalized terms not defined in this paragraph are defined in the <br />attached Terms and Conditions. Pursuant to Section 4.1 of the Terms and Conditions the INITIAL TERM shall be for 3 years. <br />Brand/Model MONETRA Brand/Model Brand/Model <br />Equipment Option OWNS Equipment Option Equipment Option <br />Fee $ 0.00 Quantity 1 Total $ 0.00 Fee $ Quantity-Total $ Fee $ Quantity-Total $ 0 <br />Payment Option OWNS Payment Option Payment Option <br />OWNS N <br />Software Vendor Payment Application Version <br />Visa Zero Floor Limit: MasterCard Kilobyte: Visa Base fI: <br />$0.1039 per transaction without corresponding authorization $0.0014 per MasterCard gross transaction $0.0023 per Visa transaction <br />MC Acquirer License Fee: 0.005% of gross MC SALES dollar volume <br />The following fees will be passed through at Association's rate: Interchange, Assessments, MasterCard Network Access Brand Usage Fee, Visa Exception <br />Item Fee, Visa Network Acquirer Processing Fee, Visa International Acquirer Fee (including High Risk), Visa Partial Authorization Non-participation Fee, Dis- <br />cover International Processing Fee, Discover International Service Fee, Discover Data Usage Fee, MasterCard AVS Card Present Fee, MasterCard Account Sta- <br />tus Fee, MasterCard AVS Card Not Present Fee, Visa International Service (including cash advance), Visa Misuse, MasterCard Cross Border (US/Non-US/Puerto <br />Rico), MasterCard Processing Integrity, Visa Debit Transaction Integrity, Visa Fixed Acquirer Network Fee, All Other Applicable Association Fees. <br />FUNDSTRANSFER <br />In accordance with the terms set out in the Terms and Conditions, transfer funds will be made to/from the account set forth in the enclosed voided check or bank <br />letter. ? Standard El Premium ? IBA ? DDA <br />TSYS Merchant Solutions, LLC is a registered agent of First National Bank of Omaha, 1620 Dodge Street, Omaha, NE 68197 800-853-9586 <br />Merchant Initials: X <br />C} k <br />N <br />2 of 4