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Home My WebLink AboutINVOICE CLOUD, INC. 1A -2015WAY 2 3 2016 0a FPAS 03 N-2015-174-01 Gt1 03 N-2015-174-01 FIRST AMENDMENT TO AGREEMENT THIS FIRST AMENDMENT TO AGREEMENT is entered into on March 31, 2016, by and between Invoice Cloud, Inc., a Delaware Corporation, (hereinafter "Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City"). RECITALS: A. The parties entered into that certain Agreement N-2015-174, dated November 19, 2015, (hereinafter "said Agreement") by which Consultant having special skill and knowledge in the field of payment processing and electronic and enhanced bill presentment and payment agreed to perform such services to the City. WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, the parties agree as follows: The parties hereto now desire to amend said Agreement to extend the Term by six (6) months beginning April 1, 2016 and terminating September 30, 2016. 2. The parties hereto now desire to amend said Agreement to expand the scope of Consultant's payment processing and electronic and enhanced bill presentment and payment services to include City's Proactive Rental Enforcement Program (PREP) accounts as set forth in Exhibit A "Invoice Cloud Biller Order Form — Add-on Services", Exhibit B "Invoice Parameters", and Exhibit C "Addendum for Application for Credit Card Processing Service Agreement/New Division Request", all three of which exhibits are herein incorporated by reference. 3. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. 4. This First Amendment to Agreement must be signed below and may be signed in counterpart and delivered by fax, email as a PDP (Portable Document Format) file attachment, or by other means that displays the original or a copy of the signatures. Any subsequent amendments may be signed and delivered in the same manner. (Signatures on following page) IN WITNESS WHEREOF, the parties hereto have executed tWs First Amendment to Agreement (he date and year first above wri2t n. ATTEST: MAIUA D, HUIZ.AR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney Lisa Storck Assistant City Attorney R,ECOMMEN'DED FOR APPROVAL: Francisco Gutierrez, Executive Director Finance & Management Services Agency CITY OF SANTA ANA ZOS Invoice Cloud, 113C. Name: OtJb hfi L.5, Title: krtstrPss Sex�crtsti�13ccr� Tax ID#,2Cr EXHIBIT A InvoicieCloud BILLER ORDER FORM —Add-on Services GENERAL INFORMATION Legal Business Nzme. City of Santa Ana Type of Buclness: Government Address, 20 Civic Center Plaza Weh Site: www.chsanta-ana.ca.uz/ Cdy:santa Ana State: CA Zip, 9'2101 PhanT11464Y53fi1 Faa ]34-64]-5089 Emall:linleken@santa-ana,org Contact Name&Title: Hans Nlelzan, P,adtManager Avg#Transectiona/Vr: 8,500 Invoice Cloud Sales Rep: Carly,, Altheide Sales Partner. Avg Transaction $ Amt: 80 Highest Invoice $Amt: 10,000 Add- On Services Pricing for Add on Services IVR(Payroti TVP.)I ❑ Credit Card Pertranzaction Cost ACH Per Tmnsactled Credit Card Max Paymant Cost: Amount +$195 visa E3 MC El __ Discover ❑ Amex❑ Cloud Store: Proactive Rental Enforcement Program Creno card Per ti anaaetion Cost: Auth+ ACO Per Transaction Credit card Max Paymant (PREP) Accounts$.20+SOBPS Caaa$.50 Ari iso® MC® __. Discover Anew ❑ Cloud Payments(Paymant Type) ❑ Credit Card Per transaction Cost ACH Per Transaction Credit Card Max Payment Cost Amount Visa/MC ❑ Discover ❑ Anrax ❑ EZPay ❑ Card Swipes Costs Online Bank Direct _ ❑ Credit Card Processing ❑ IC Payment' transaction Fee - Credit Card per TranaacYloo Check 21(Park,&Bec) ❑ Check Reader ❑Check ❑Credit E.MQy X$ Monthly tease❑ Card 84Y ❑ BILLER BANK MUSTINCLUOE VOIDED BUSINESS CHECKFOR EACHACCOUNO: City oSaata Ana(sane as existing) Bank Name: J.P. Morgan Address: 3 Park Plaza Fir 9 OR, wide, CA 92614 Phone: 949833-4063 Dep Depository Your invoice payment Routing#±311271=627 AccnuntN 913309500 Feas Yom Invoice and payment Baer,# Account# 935309500 and Agreement A. By signing be low, the Biller hardily awhorzos Inde. cloml, Inv. I"leeolcn Cited"j to I,Iate a end execute debitleredlt entries to Its diedMng/depaslt dcrou'It (a) indlaatd above at [he depository financial imtitution(d named above and to decd/credit the same such arm t(s).Th. Biller arknowledgrs thatthe>r'iglnallai ofACH transaclmns to Its socountis) must comply wmI the proei.a'ons of U.S. law. This authority is to rernair. in full force and effort until it) Invoice cloud has revolved written na:irldetion(by elecrronic m'U.S, mail)fr. the Biller of Its unn udnn II I tune and manner n a allow Involve Dinedneem a r"O% has Iner. nppnrturdty to act On it, bort not less than 10 business Jays notion; and lid n11 obligations of the Nor to Inaorce cloud that have arisen under thb Agreement and all other agreements have plan paid in full The Blller most ego notify Invoice Claud, in .1111bg,(by abum nn. or U.S, mall) when o change In amount msmb.r(s) dOr conk has incurred at which time this authorization shall apply to such new/change) amount. Th(s n fir'stian must be received ewt 10 business days ofahnngd A fee will he charged for try returned ACH ebits. B. By signing below, the Biller named: (111 hesread, agreed to, and acNnowiedges receipt of the teems and conditiens of the Blller Agreement, attachad handle and incorporated herald by ra(erenco (2) certifies to Invoice Cloud that he/she is authorised to sign this Order Fenn; (3) eenifte, that all Information and documents submitted In connactlon writ Its Order Farm are Moa and complete; (4)anthprdes bwole, Cloud or its agent to verify arty of the information given, including credit references, and to Obtain vredit mporls(Indeding a spouse if in a community, probe ny staud;(4) vannas to pay this Monthly Access Fee through the last day of the month fallowing the effective data Of termination as provided fn the Billing Agreement; (5)agrtesshat Biller and each transaction submitted will be bound by File Older Form and the filter All e.ment in its endraty;(6) delete that Biller will submit transactions Only in avcordanee 'fill :he'erfarmatlon In bible Order Form and 011ier Agreement and will Immediately Inform Involve Cloud, by small (sontrarts(grnrvoieeebud.pom) if any Information In Uses Order Form chenledThe terms ant) uonditione and cher Order form and the Diller Agreemopt cansmme the entire Integrated apkr Agreement by and between ale, old Inured Claud and (7) the blheragrees and understands that mrtstalmna sums due antl owing m Involve Clmrd., will be ehalyed daily or monthlY and debited from its .rant dnpentory .carom. Non.aoffil bunds for these debits are gr ... di fora change In fees or tennineHan of Yhes Agrneme hit In the event of wn-payment Of any same do.,Invo[ve Cloud reearves the righ to withdraw such rim, from the ebmabt depository amount at any tine to unsure payee hit of the same. C. By dr, 11 balmy, the biller ornery [,.a parmissien to[Ovate. Claud to acl.a his/her dada hint rd Tons union, Feuif., or atberemdibreportina eburvy. I The Order Perin and the Biller Agmemant will b.come effverive onll when 111mal-Irred by lnwolce Cloud end upnnI'lletlon by the Biller Of thlyd party aereomerrt rvyuded by Insula Claud to parrnit use of the payment funrdmt of the Ser,tra. In WITNi W1I DOF,mO pa les hereto have executed thin o-alnenlesuf thie 31" day Of March, 2016 Accepted by Biller: ❑ y NY: Y_��a^^—""�i....,•'�—i___, _-__ yy Prfrll Name; Ff_SS_r_ inane Iter r. Accepted by invoice Cbbd: ;a BY:X K {�—?.�„r m^I^✓::.k�.�=4z print Name'_... t.G �ior'h' .0 2rt r�t•'�'^F'> .. ; 1- _:. Ver. 2.7 Invoice Parameters eters • • _ Proactive Residental Enforcem Program (PREP) Accounts ' • ' 3/31 /2016 Invoicing Parameters sheet must be completed for each invoice f e. ° - In-house °°= Non -Submitter • • • ®Visa ® MasterCard ❑ Discover ❑Amex ®EFT/ACH • • ❑EBPP ®Cloud Store ❑ Cloud Pay ❑ OBD ❑ IVR ❑Kiosk ♦ Billing Frequency: Annually Number of Bills: 8,500 Number of Cycles: F Number of Installments: 1 Average Invoice Amount: ', 80 Highest Invoice Amount: $ 10,000 Billing Months (please select the applicable months below): ❑Jan ❑Feb []Mar ❑Apr ❑May ❑Jun ❑ Jul ❑ Aug ❑ Sept ❑Oct ❑ Nov ❑ Dec ® All • a ®a ❑ 1 st _ I Oth ❑ 11th -20th ❑ 21st -31st ♦ + • ®• • ❑ Biller ❑ Template ❑ Bill Print Vendor (please complete below) .. EMU= IF Hardware: Choose an item. QTY Choose an item. Provided by: ❑ Sales Rep ❑ Operations Per Unit Price: $ Shipping Address: (if different than location address) Total Due: $ Item Paid b . payer Item Paid by Biller ❑ Credit Card: ® Credit Interchange, fees, dues assessments + % with $ Minimum Card: Authorization $ F020' + 50 %BP ❑ EFT/ACH: I $ per item ® EFT/ACH: $ 0.50 per item ❑ Flex Pay ACH: $ per item ❑ Flex Pay ACH: $ per item Item Paid by Item Paid by Biller ❑ Credit Card: ❑ Credit Interchange, fees, dues assessments+ %with $ Minimum Card: (Without Visa Acceptance) Authorization $ + %BP ❑ EFT/ACH: $ F_ Per item ❑ EFT/ACH: $ Per Item ❑ Credit Card Service Fee: $ Max Cap for Credit Cards: $ ❑ EFT/ACH: Service Fee: $ u, ❑ Paid by payer ❑ Paid by Biller ❑ Paid by payer Service Fee + $ ❑ Paid by Biller $ per item surcharge Proactive Rental Enforcement Program (PREP) Accounts Cloud Store requires a customer loxbox file (see business license Cloud Store). Please see BL Cloud Store or contact City for exact specificiations for the file and form at. ,. .,._.. •a ,. w. ° 7/1/2016 _. • • if '. Hans Nielsen '.. Please note the above requested date is not guaranteed. The implementation time frame is not guaranteed) subject to change and delays to workload, systems/data requirements, biller cooperation and other factors. EXHIBIT C CHASE Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com Phone: (603) 896-6000 • Fax: (603) 896-8715+ Merchant _ Services@ChasePayinentech.com A A Division Date: 3/31/16 CompanyID#: Projected Live Date: 711/16 SECTION 1: COMPANY/CONTACT INFORMATION Company Legal Name: Invoice Cloud, Inc Company Taxpayer ID#: 26 3972596 Contact Name: Robert Lapides Phone #: (781) 848-3733 EXT 223 Fax #: 877-256-8330 Email Address: blapides@invoicecloud.com Transactions processed for this new set up request belong to: Merchant whose company legal name is represented above... OR An Additional Company whose legal name is: City of Santa Ana and is a ❑ wholly-owned ❑ partially owned ® affiliate ❑ registered DBA or ❑ Other (explain: ) of the merchant noted above. On behalf of Invoice Cloud Inc (Company Legal Name) I, Robert Lapides EVP (Print Name) (Title) verify that the account set-up information is accurate, that I have the authority to make such a request and thus, it should be used to set up an additional account for our company. SECTION 2: BUSINESS UNIT (if different from division name) Parent Business Unit (up to 30 bytes) Parent Bus.Unit # Name (if applicable): (if applicable): Business Unit Name: City of Santa Ana (up to 30 bytes) Business Unit #: SECTION 3: FUNDING if new banking see section 9) If funds should be deposited to an existing bank account please complete the following: If USD or CAD, will funds be deposited into your existing Bank Account set up with Chase Paymentech? ❑ Yes or ❑No If yes, Bank Account # (Section 9 does not need to be completed) If funds should be deposited to an existing funds transfer instruction please complete the following: If USD or CAD, will this division utilize an existing Funds Transfer Instruction (FTI)?❑ Yes or ❑No If no, a new FT1 will be created. If yes, provide FTI # (Section 9 does not need to be completed) Rev11/18110 1 NewnivisionSetuploboo C9--lASE vP Merchant Services • 4 Northeastern Boulevard, Salem, NM 03079-1952 • www,chasepayinentech.coni Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_ Services@ChasePaymentech.com SECTION 4: 1099K CONTACT INFORMATION (W-9 required if new US entity andlor taxpayer ID, W--8 required for Canadian Transaction Division's Taxpayer ID #/No. 95-6000785 Same as Corporate Yes ❑ No El 1099K Contact Name Francisco Gutierrez 1099K Contact email address: fgutierrez@santa-ana.org This is the contact that will receive the 1099Kmailing to the address listed on the W-9 supplied(only required if different than Corporate) SECTION 4a: TRANSACTION DIVISION Division Name: City of Santa Ana -PREP (up to 30 bytes - this will appear on your Financial Reports) Currency (list only 1 each per division): Presentment: US Settlement: US '** If using our Cross Currency Product — please provide both the Presentment and the Settlement Currencies The following field appears on the customer's statement and identifies the merchant name for the consumer and credit card organizations. To further aid consumer recognition, Visa has sanctioned the abbreviation of the merchant name. It must be separated from product information by an asterisk (*), which must appear in the 4th, 8th or 13th position. The asteriskcannot be used for Retail Merchants, Internet service providers, e-commerce merchants may utilize a URL Instead of Customer Service Phone if not processing any Mall -order transactions (URL must only be 13 bytes) Cardholder Descriptor (Foran card types with the exception ofAmedcen Express): x s * C I i I t I y I I o I f S I a I n I t I a A n a (22 bytes) Customer Service Phone #: 7 1 4 - 6 4 7 - 5 3 3 5 (13 bytes (Required for Mail Order or Recurring) City: (Required for Retail) (13 bytes) URL: (optional, if phone# provided above) (13 bytes) Division Location Address: 20 Civic Center Plaza Country: USA (Must be a street address, PO Boxes not acceptable) City: Santa Ana State/Prov: GTA] Zip Code (US): 1 9 2 1 7 1 0 1 (For Retail -City above must match City Location) Postal Code (Inti): C Postal Code (Can): (6 bytes) (StatelProvince and PostallLip codes must match the address given above) Product/Service Description (Enterproduct description, i.e. clothing, P I R I E I P books, membership) Publication Descriptor (Please provide only d required by your submitter): Avg. Trans. $ Amt: 80 Avg. # Trans./Yr: 850 Projected Refund % 10 BPS How do you market this product? (Check onlit those that apply to this division) ❑ Catalog ❑ Direct Mail ® Internet ❑ Space Ad ❑ TV ❑ Outbound Telemarketing ❑ Other How will consumers provide credit card information to you when they order this product? (Select only one): ❑ Retail ❑ MailiPhone(MarketingMaterialReguimd) ® Internet(Pleasepmvide your URL): http:tl www.invoicecloud.comisanta- ana If internet is selected and the website is not yet available to consumers please complete a Marketing Material Supplement form which you may obtain from Merchant Services or your account executive. If Internet, please advise: Select one: N SSL ❑ SET ❑ No encryption method Will the consumer be able to place their order and provide their credit card info (or electronic check info) through this website? ® Yes ❑ No Is the web site secure, i.e., will the information that the consumer provides, such as their name and credit card number be encrypted so that it can't be read or intercepted by other people? ®Yes [:]No Maximum Sale $125k Transaction Amount: (Default $25,000 U,S. dollars or established international currency equivalent per transaction) Maximum Refund $125k Transaction Amount: (Default $25,000 U.S. dollars or established international currency equivalent per transaction) (Approval will be required far any temporary or permanent increases to this ceiling limit). Please check the consumer's payment option for this division: (Select only one): Revl 111 Bit 0 2 NewDivisionSetuplcboo 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 CHASE 0 Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant—Services@ChasePaymentech.com SECTION 6: PRODUCTS & SERVICES Please indicate if you will be using any of the following additional services. Please note that some of these services May require an additional contract addendum and/or information if you currently do not have the service. (For information on these services, please contact your Chase Paymentech Relationship Manager) 1. ❑ Authorization Recycling # of recycle attempts: _ (Default is 3 if left blank) # of days between attempts: _ (Default is 3 if left blank) Output Options: ❑ Total recommended ❑ Standard 2. ❑ MC/IM SecureCode ❑ UKDM SecureCode 3. ❑ Account Updater (US Only, Canada & UK Only): ❑Submitting or ❑Extracting (if extracting Indicate # of Days: (1-180 days) (if Orbital Gateway For UK -Account Updater Visa EU Merchant ID required SECTION 7: METHODS OF PAYMENT_- ® Visa ® MasterCard ❑ JCB (US & Yen only) ❑ UK Maestro/Switch Solo (UK domicile and GBR currency only) (As a default Discover will be set up except for those merchants that are retained by Discover, or do not have a company location address in the United States. Asa default Discover Diners added whenever Visa and MC are added.) ❑ Discover Canada (CAD only) ❑ Discover Diners Canada (CAD only) ❑ Private Label vendor: Private Label attributes Please supply attributes for Private Label Vendor (Please work with your Vendor to obtain these attributes — for example — HRS Household — Please provide Credit Plan #) ® Discover (conveyed only) (US only) SE# I I I I I I I I I I (15 bytes) ❑ American Express(conveyed) SE# I I I I I I I (10 bytes) As a rule: (US SE should begin with "1-5", International SE should begin with a "9 ;. Canadian SE should begin with a "93'; International SE valid on some cross currency divisions dependent on presentment currency) AMEX Parameter Information Cardholder Descriptor: (Appears on your American Express cardholder statemeny(All othercard types use descriptor in Section 4) (20 bytes) TAA #1: (22 bytes) TAA #2: (22 bytes) TAA #3: (22 bytes) TAA #4: (22 bytes) Do you support American Express Partial Auths? American Express - Yes ❑ No ❑ For American Express Only, if yes — please select the following applicable option: Auth and Balance Return ❑ Partial Auth ❑ Both ❑ How have you been classified as a merchant by American Express?: (please select one) or ® Electronic Check Processing Parameter (US and Canadian only) Company Name: (16 bytes) Item Description: I P I R I E I P (10 bytes) Preferred Delivery Method: (select only one) ® Best Possible (US only) ❑ Facsimile Draft (US only) ❑ ACH/EFT (US & Canada) Redeposit Parameter? ❑ Yes ® No Indicate # of Days: 0 The default is "1" How do you obtain authorization from consumers? (Select only one) ❑ Written consent ❑ Telephone ® Internet ECP Maximum Sale (If blank, these amounts will default to match the Stank Card Transaction Amounts. Enter an amount Transaction Amount: here only if the Maximum Sale and Refund amounts for ECP should be different than Bank Card) ECP Maximum Refund (If blank, these amounts will default to match the Bank Card Transaction Amounts. Enter an amount Transaction Amount: here only if the Maximum Sale and Refund amounts for ECP should be different than Bank Card) (Approval will be required for any temporary or permanent increases to this ceiling limit). Rev11/18/10 4 NewDivisionSetup/cboo CHASE Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • wvw.chasepaymentech.com Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant _Services n ChasePaymentech.com SECTION 7: METHODS OF PAYMENT (continued) ❑ PINIeSS Debit (Not applicable for retail merchants) Please select the network vendors that you have approval from: NYCE ❑ STAR ❑ Pulse ❑ Accel ❑ ❑ PIN Based Debit (Aoelicable to retail merchants only) PIN BASED DEBIT Requires a PIN Pad - please complete section 8, item #4, entitled "Will you be using a Point -of -Sale terminal (US and Canada only) or Point -of -Sale software?" If checked above, this division will be setup for the following network vendors with the exception of EBT: (Pulse, NYCE, STAR, interlink, Maestro, ACCEL, Alaska Options, Jeanie, AFFN, CU24) EBT required: Yes ❑ or No ❑ ? FCS# required if processing food stamp transactions: ❑ Gift Card (U.S. only) ❑ Bill Me Later® payment option (US only) ❑ European Direct Debit For EURO only, (Valid only for Euro currency divisions Descriptor (18 bytes) Default will be the first 16 characters of your Cardholder Descriptor unless otherwise noted Please select country(s) in which you will offer Direct Debit: AT (Austria) ❑ BE (Belgium) ❑ DE (Germany) ❑ NL (Netherlands) ❑ FR (France) ❑ For GBP only: (Valid only for GBP currency divisions) Descriptor I I I —I I LL� (7 bytes) Default wilt be the. first 7 characters of your Cardholder Descriptor unless otherwise noted Country: UK ❑ Redeposit Parameter? ❑ No ❑ Yes Indicate # of days: The default is ❑ PavPai (Valid for Us currency only) Payer Email Address: (32 character Limit) (must be a unique email address belonging to the merchants business and must be working at the time of account creation. Note: No two accounts or divisions can share the same Payer email address.) Customer Service Email Address: (127 characterlimit) Primary Contact Name: Phone: Email: Descriptor : I P I A I Y I P I A I L (18 bytes) Business Name: Customer Service Phone# (optional) (75 character limit and must not contain the following characters &, <, and >.) Sales Venue: ❑ eBay ❑ Other Marketplace ❑ My own Website(include http:) ❑ Other Avg.Transaction Price: $ Avg. Trans/Yr: Percent of Annual revenue from online sales: % Authentication Method: the method by which you (the merchant) will authenticate your customer with PayPal–you must choose only one) PayPal Direct ❑ Cardinal Commerce Centinel ❑ (if Cardinal Commerce is involved, please complete the following): Are you using Ecometry or CommercialWare Software to facilitate your Paypal Integration? Yes ❑ Na ❑ Time Zone (based on merchants location): SSL Security: (check one) HTTP ❑ or HTTPS ❑ Tech Contact Name: Phone: Email Address: Rev11t18110 5 NewDivisionSetupicboo CHASE C'3 Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com Phone: (603) 896-6000 • Fax: (603) 896-87'15 • Merchant_Services@ChasePaymentech.com SECTION 8: PROCESSING METHOD Who will be submitting transactions to Chase Paymentech? ® Merchant ❑ Other Co. Name: Invoice cloud (i.e. fulfillment co. orECommerce provider) If known, please provide the Presenter ID # (PID): or Submitter # (SU): ❑ 1. Will you be submitting transactions from a computer system? What is the name of the manufacturer and model of your computer platform? What is the name of the manufacturer and model of your modem? ❑ Internal ❑ External Will you be coding to Chase Paymentech specifications? ❑ Yes ® No Will you use NetConnect Batch for Connectivity? ❑ Yes ® No Will you use NetConnect for connectivity for online authorization only? ❑ Yes ® No If yes, NetConnect Contact Name: _ Email: Userld (if existing): Phone: if applicable, name the software vendor and application you will be using to format your files: ❑ 2. Will you be using the Orbital Payment Gateway? *If this is the first division using the Orbital Payment Gateway, please contact your Relationship Manager Primary Contact*: Tony Cordova UserlD (if existing) Address: 642 E Washington St. City: Brownsville State: TX Zip/Postal Code: 78520 Country: USA Phone: 956-542-6825 Email (required): tcordova@invoiceeloud.com *Primary contact must be the merchant contact for security needs. Auto -Settle Time: none ❑ to allow Gateway to settle. AM or ❑ PM To meet 10 ET Host window, this should be set no later than Spm Merchant Time Zone: NA Note: The Auto -Settle time is based in the merchant time zone. (US time zones only) Profile Management required? ❑Yes or ®No Level of access: ❑ Merchant or ❑ Chain (select one, default is Merchant) VT import Functionality? ❑ Yes ❑ No Auth Recycling? ❑ Yes ❑ No # of Recycle Attempts: (oefauti is 3) # of Days between attempts: ❑ 3. Wiil you be using: ❑ Paypal/Verisign ❑ CyberSource ❑ 4. Will you be using the iTerminal? (retail divisions only) Primary Contact*: UserlD (if existing) Address: City: State: Zip/Postal Code: Country: Phone: Email (required): *Primary contact must be the merchant contact for security needs. Auto -Settle Time: ❑ AM or ❑ PM To meet 10 ET Host window, this should be set no later than Spm to allow Gateway to settle. Merchant Time Zone: Note: The Auto -Settle time is based in the merchant time zone. (US time zones only) Magtek Reader Needed? ❑Yes [:]No If Debit, Pin Pad Needed? ❑Yes [:]No If Yes, NB&7100❑ or Verifone SC5000❑ (if Yes, Magtek Readers are purchase only) (iTerminal is only certified to utilize the above PinPads and are purchase only) Ravi 1/18110 6 New Oivisionfeboo Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant—Services@ChasePaymentech.com SECTION 8: PROCESSING METHOD (continued) ❑ S. Will you be using a Point-of-sale terminal (US & Canada only) or Point -of -Sale software? Point of Sales Software: POS/Software Name: Host Capture ❑ Terminal Capture ❑ Connectivity: Dial ❑ NetConnect El (if Netconnectsee requirements below) If NetConnect: Where is your software hosted/configured? Corporate location[] or Division location❑ NetConnect Contact Name: Email address: Userld if existing: Phone: PIN Pad Type and quantity?(forPIN BASE DEBIT Only) Quantity: Is PIN Pad Existing ❑ or PIN Pad Purchase Needed❑ Injection - Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key? ❑ Who will be injecting the Encryption Key into your PIN Pad? Please select one below: ❑ Chase Paymentech Solutions ❑ Other Vendor Name: Equipment/Terminals: Will you ❑ Purchase? ❑ Rent? (US Only) ❑ Use existing equipment? ❑ Yes ❑ No If purchase or rent, date needed by: Terminal quantity? Printer quantity? Terminal/Equipment Type: Printer Type: Host Capture ❑ Terminal Capture ❑ Connectivity: Dial ❑ NetConnect ❑ Wireless ❑ (If NetConnect see requirement below) NetConnect Contact Name: Email address: Userld if existing: Phone: PIN Pad Type and quantity? (for PIN BASE DEBIT Only) Quantity: Is PIN Pad Existing ❑ or PIN Pad Purchase Needed[] Injection- Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key? ❑ Who will be injecting the Encryption Key into your PIN Pad? Please select one below: ❑ Chase Paymentech Solutions ❑ Other Vendor Name: Store Phone #: Terminal Line Phone #: Customer Service Phone # (if different then Store Phone #) Equipment/Kits/Imprinters Ship To Address (if different than store location) Please ensure a contact will be available to accept shipment. Street Address: Dial Out Prefix (9,8,e): Attention to: Default will be Store Manager City: State/Prov: Zip/Postal Code: Country: Ship to contact's phone#: Ship to contact's email: Store Opening Date: Special Requirements: Do you require a "re -program" kit? (overlay, quick reference guide, etc.) Yes❑ No[] Do you require an Imprinter? ❑Yes ❑No Type of Imprinter required: With Dater ❑ or Without Dater ❑ Do you require an Imprinter Plate? ❑Yes ❑No Do you require a Welcome Kit? (this includes sales drafts, credit drafts, etc) Yes❑ No❑ Rev11l18110 7 New Divisionlcboo Merchant Services • 4 Northeastern Boulevard, Salem, NF1 03079-1952 • www.chasepaymentech.com . Phone: (603) 896-6000. Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com Nntar Whan setfina un multinie hank arenunts. n/easy rmmniete a senarate form for each. SECTION 9: BANK ACCOUNT INFORMATION Check only one Settlement Currency in which we Deposit Complete all sections of the 7 options will fund to you (Country where your Bank Acct listed: below 1 2 Residos) 1 (ABA #) Option #1 N _ USD USA A, E See section A Note section Option #2 ❑ CAD CAN B1 to B3 E Option #3 ❑ USD CAN B1 to B3, D3, D4, E Option #4 ❑ USD Int'I C1 to C3, D1, D3, D4, E list country funds are being deposited in Please Nate: Swift code is required if your division is located outside of the US or Canada and is settling funds in USD. Wire transfer requires both ACH ABA# and Fedwire#lRoutin #. Special Wire Instructions: 60 bytes) Option #5 ❑ ❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑ Euro Bank or SAME as nd/or C2, C3, E City of Santa Ana Country: United States HKD, ❑DKK, ❑CHF, ❑NOK., ❑SEK, presentment/settlement currency ❑NZD, ❑ZAR Option # 6 ❑ []Euro,❑GBP, El JPY, ❑AUD, El If DIFFERENT than Settlement nd/or C2, C3, D1 FIKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK, Currency FandtorD2, D4, E ❑NZD, ❑ZAR, ❑USD Intl ist count funds are bein de osited InOption #7 El ❑Euro, ❑GBP, ElJPY, ❑AUD, [ICAN o HKD, ❑DKK, ❑CFIF, ❑NOK, ❑SEK, ❑NZD, ❑ZAR Section A: US BANK ACCOUNT INFORMATION select onjX one method of transfer 0 ACH Transfer 3 2 2 2 7 1 6 1 2 1 7 1 (ABA #) [I Wire Transfer (See Note) ❑ Swift Transfer (See Note) t I +ffi(Fedwira#!Roofing#) (Swift Code: tato r1 bytes) Please Nate: Swift code is required if your division is located outside of the US or Canada and is settling funds in USD. Wire transfer requires both ACH ABA# and Fedwire#lRoutin #. Special Wire Instructions: 60 bytes) Bank Account #: 935309500 Company Name: (As appears on Bank Account) Financial Institution Name: J.P Morgan City: Irvine State: CA Zip/Postal Code: 92614 0 Checking OR ❑ Savings City of Santa Ana Country: United States f33t# B1 Institution Number: B2 Swift Code: (8 to 11 bytes) B3 Bank Account# Financial Institution Name: City: ❑ Checking OR Savings Province: NT INFORMATION: Tr EFT Branch Transit Number: _I—J—L I .-J (required if settlement is USD) Company Name: (As appears on Bank Account) Postal Code: Country: Canada Rev11118/10 8 New Divisiordeboo Merchant Services • 4 Nonheastern Boulevard, Salem, NH 03079-1952 « cvww.ehasepaymenoch.com a Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com C1 I Swift Code: (8 to 11 bytes) C2 Sort Code: (Required in Great Britain Only) C3 IBAN/Bank Account # Company Name: (As appears on Bank account) Financial Institution Name: City: State/Province: Special Wire Instructions: (60 bytes) Postal Code: Country: Section D; INTERMEDIARY/CLEARING BANK ACCOUNT INFORMATION Note: Por#nel Deposits going throd9h J.P. Morgan Chase in Eondon, lMermedfar,�r is not required. Come fete Section " only. D1 Swift Code: (8 to 11 bytes)�— _ D2 Sort Code: (Required in Great Britain Only) D3 Wire Transfer: (USA Only) (Routing #) D4 Financial Institution Name: City: _ State/Province: Postal Code/Zip: Country: Special Wire Instructions: (60 bytes) Section E. Signature "On behalf of City of Santa Ana 1, Francisco Gutierrez represent and warrant (Merchant Legal Name) (Print Name) that I have the authority to add banking information and I verify that the above banking Information is accurate and should be used to transfer funds accordingly." - Director of Finance 3131/2016 :�4)c N A-6tFibrized Signature" Title Date (-Must be signed by Executive or Financiat Contact) Note: In order to process this recluiestt please attach an original voided check (starter check or bank statements not applicable) or a bank letter of verification. Rev1l/18110 9 Naw Division/cboo Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com SECTION 10: REPORT CENTER AND TRANSACTION HISTORY ACCESS FORM 1. Please be sure to include the information below for additional contact that requires access to Transaction History and/or Paymentech Online Report Center. 2. Report delivery will be web based via Paymentech Online. 3. Please note: You, the merchant, are responsible for advising Chase Paymentech of changes in Paymentech Online contacts. Chase Paymentech assumes no responsibility or liability of any kind for Merchant's failure to advise Chase Paymentech of changes to or elimination of Paymentech Online Users, Please be sure to complete all fields below. Salutation: Check one: M Mr. Elms. ❑ Mrs. Name: Robert Lapides Title: EVP Phone M 781-848-3733 Fax #: 877-256-8330 Address: 35 Braintree Hill Office Park, Suite 100 City: Braintree State/Prov: MA Zip/Postal Code: 02184 country: USA Email Address: (40 bytes) blapides@invoicecloud.com (username@dc main. com} Does this contact have a Paymentech Online User ID? ❑ Yes M No If yes, please provide User ID: Does this User require access to: ❑ Reporting ❑ Transaction History M Both Account Masking M Yes ❑ No For existing merchants — Is this User replacing an individual with Paymentech Online Access? ❑ Yes ❑ No If yes, who? Has this individual left the company? ❑ Yes ❑ No For existing merchants — Is this Users access to be mirrored like another User Paymentech Online Access? ❑ Yes ❑ No If yes, who? Salutation: Check one: ❑ Mr. M Ms. ❑ Mrs. Name: Deborah Bowler Title: VP of Operations Phone #: 781-848-3733 Fax #: 877-256-8330 Address: 35 Braintree Hill Office Park, Suite 100 City: Braintree State(Prov: MA Zip/Postai Code: 02184 Country: USA Email Address: (40 bytes) dbowler@invoiceeloud.com (username@domain.com} Does this contact have a Paymentech Online User ID? ❑ Yes ❑ No If yes, please provide User ID: Does this User require access to: ❑ Reporting ❑ Transaction History M Bath Account Masking M Yes ❑ No For existing merchants — Is this User replacing an individual with Paymentech Online Access? ❑ Yes ❑ No If yes, who? Has this individual left the company? ❑ Yes ❑ No For existing merchants — Is this User's access to be mirrored like another User Paymentech Online Access? ❑ Yes ❑ No If yes, who? For additional Users, please :submit -additional forms. I, Robert Lapides EVP verify that the (Print Name) (Title)* contact information is accurate, that I have the authority to make such a request and thus it should be used to grant access for these contacts to access Transaction History and/or the eport Center. Signature: drh .r1 '(must be signed 6y ExecuBve or Financia[ Contact) Rev11/18/10 10 New Division/eboo