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CHASE ! ll
<br />I ayrnen c'ch
<br />r
<br />Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www,chasepaymentech.com .
<br />Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
<br />Note: When setting up multiple bank accounts, please complete a separate form for each.
<br />SECTION 9: BANK ACCOUNT INFORMATION
<br />select only one method of transfer)
<br />Check only one
<br />Settlement Currency in which we
<br />Deposit
<br />Complete all sections
<br />of the 7 options
<br />will fund to you
<br />(Country where your Bank Acct
<br />listed:
<br />below
<br />7
<br />Resides)
<br />❑ Wire Transfer (See Note)
<br />Option #1 ®
<br />USD
<br />USA
<br />A, E
<br />See section A Note section)
<br />Option #2 ❑
<br />CAD
<br />CAN
<br />B1 to 133, E
<br />Option #3 ❑
<br />USD
<br />CAN
<br />B1 to B3, D3, D4, E
<br />Option #4 ❑
<br />USD
<br />Intl
<br />C1 to C3, D1, D3, D4, E
<br />list count funds are being deposited in
<br />Please Note: Swift code is required if your division is located outside of the US or Canada and is settling funds in USD.
<br />Wire transfer requires both ACH ABA# and Fedwire#/Routin #.
<br />Special Wire Instructions: 60 bytes)
<br />Option #5 ❑
<br />❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑
<br />Euro Bank or SAME as
<br />C1 and/or C2, C3, E
<br />B1
<br />HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK,
<br />presentment/settlement currency
<br />❑NZD, ❑ZAR
<br />I I (required if settlement is USD)
<br />B2
<br />Option # 6 ❑
<br />❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑
<br />If DIFFERENT than Settlement
<br />C1 and/or C2, C3, D1
<br />I
<br />HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK,
<br />Currency
<br />and/or D2, D4, E
<br />❑NZD, ❑ZAR, ❑USD
<br />Int'I
<br />B3 Bank Account # Company Name: (As appears on Bank Account)
<br />Financial Institution Name:
<br />City: Province: Postal Code: Country: Canada
<br />❑ Checking OR ❑ Savings
<br />(list country funds are being deposited in
<br />Option #7 ❑
<br />❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑
<br />CAN
<br />61 to B3, D1, D4, E
<br />HKD, ❑DKK, ❑CHF, []NOK, ❑SEK,
<br />❑NZD, ❑ZAR
<br />Section A: US BANK ACCOUNT INFORMATION
<br />select only one method of transfer)
<br />® ACH Transfer
<br />3
<br />2
<br />2 1
<br />2
<br />7
<br />1
<br />1 6
<br />1 2
<br />7
<br />(ABA #)
<br />❑ Wire Transfer (See Note)
<br />(Fedwire#/Routing #)
<br />❑ Swift Transfer (See Note)
<br />(Swift Code: (a to 11 bytes)
<br />Please Note: Swift code is required if your division is located outside of the US or Canada and is settling funds in USD.
<br />Wire transfer requires both ACH ABA# and Fedwire#/Routin #.
<br />Special Wire Instructions: 60 bytes)
<br />Bank Account #: 935309500 Company Name: (As appears on Bank Account) City of Santa Ana
<br />Financial Institution Name: J.P Morgan
<br />City: Irvine State: CA Zip/Postal Code: 92614 Country: United States
<br />® Checking OR ❑ Savings
<br />Section Bc CANADIAN BANK ACCOUNT INFORMATION: Transfer Method EFT Only
<br />B1
<br />Institution Number:
<br />EFT Branch Transit Number:
<br />I I (required if settlement is USD)
<br />B2
<br />Swift Code: (8 to 11 bytes)
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />I
<br />B3 Bank Account # Company Name: (As appears on Bank Account)
<br />Financial Institution Name:
<br />City: Province: Postal Code: Country: Canada
<br />❑ Checking OR ❑ Savings
<br />Rev11/18/10 8 New Division/cboo
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