Okaloosa County BOCC — October 5, 2013 — PayPros Merchant Application and Agreement with Addenda — reading text

( P) Payment Processing, Inc. Merchant Application & Agreement PAYMENT PROCESSING USE ONLY MERCHANT F# NEW MERCHANT McC CARD ACCEPTANCE REQUESTED: [APPLICATION ID. ADD LOCATION CREDIT O DEBIT 1 533771 34935 ERCHANE INFORMATION NAME OF CORPORATION OR PARTNERSHIP MERCHANT “DOING BUSINESS AS" NAME Okaloosa County LOCATION ADDRESS (NO PO BOX) CORPORATION ADDRESS 804 Lewis Turner Blvd. suite 402 CORPORATION CITY, STATE, ZIP LOCATION CITY, STATE, ZIP Fort Walton Beach, FL. 32548 CORPORATE CONTACT LOCATION CONTACT CORPORATE TELEPHONE NUMBER EIN/FEDERAL TAX ID # HOW LONG AT THIS LOCATION BUSINESS START DATE (MM/YYYY) 850 651- oe als signing the application is required below.) NAME OF OWNER/OFFICER #2 NAME OF OWNER/OFFICER #1 TITLE #1 PERCENT OF OWNERSHIP TITLE #2 PERCENT OF OWNERSHIP: RESIDENCE ADDRESS #1 RESIDENCE ADDRESS #2 RESIDENCE CITY, STATE, ZIP #1 RESIDENCE CITY, STATE, ZIP #2 HOME TELEPHONE #1 SOCIAL SECURITY #1 BIRTH DATE |HOME TELEPHONE #2 SOCIAL SECURITY #2 BIRTH DATE NUMBER OF DAYS TO PREPARE TYPE OF OWNERSHIP: PRIMARY TYPE OF BUSINESS: (SOLE OWNERSHIP Cl PARTNERSHIP CI RETAIL O WHOLESALE 0 RESTAURANT SHIPMENTS FOR DELIVERY TO CUSTOMER FROM C1JOINT VENTURE 0 LLC PUBLIC CORP CILODGING O MAIL ORDER DATE OF ORDER: _0-7 Days O PRIVATE CORP 0 GOVT CORP C TELEPHONE ORDER CNON PROFIT O OTHER Cl CONVENIENCE STORE Cl INTERNET MAILIFAX CHARGESIRETRIEVALS TO: G CONVENIENCE STORE WITH GAS CLLOCATION ADDRESS Cl CORPORATE ADDRESS (HOME BASED Oi OTHER DELIVER STATEMENTS TO: IF INTERNET BUSINESS, LIST WEBSITE ADDRESS: CILOCATION ADDRESS 1 CORPORATE ADDRESS nto hea % ANNUAL CREDIT CARD SALES GENERATED: |% OF CUSTOMER ORDERS DELIVERED IN: MCIVISA SALES ARE CHARGED (CHECK ONE): MAILIPHONE % |o-7 DAYS % | CAT DATE OF ORDER INTERNET % 18-14 DAYS % | OAT DATE OF DELIVERY CARD SWIPE % |15-30 DAYS % | CAT DATE OF SHIPMENT HAND.KEYED ITEMS. EACE.TO.FACE..._._.___%_|MORE THAN 30DAYS. | OTHER TOTAL 100% |TOTAL 100% DESCRIBE THE MERCHANDISE SOLD OR SERVICE PROVIDED [MASTERCARDIVISA REFUND POLICY: z DO YOU HAVE A REFUND POLICY FOR YOUR MASTERCARD/VISA SALES? a “YES. o NO CHECK THE APPLICABLE REFUND POLICY: O EXCHANGE 0 STORE CREDIT O MC/VISACREDIT O OTHER IF MC/VISA CREDIT, WITHIN HOW MANY DAYS DO YOU DEPOSIT CREDIT TRANSACTIONS? QO 0-3 DAYS Q 4-7 DAYS O 8-14 DAYS PREVIOUS PROCESSING HISTORY 22 g 5 CURRENT CREDIT PROCESSING BANK, IF APPLICABLE BANK OR PROCESSOR NAMI THIRD PARTY CARDHOEDER DATA STORAGE LIANCE =: IS CARDHOLDER DATA STORED? O YES O NO IF YES, WHERE IS CARDHOLDER DATA ‘STORED? NAME OF PRIMARY CAP/VAR: O MERCHANT O CAP ONLY O FDMS EXPORT ONLY O BOTH MERCHANT AND MERCHANT CAP/VAR, NAME OF SECONDARY CAP/VAR: DO UNKNOWN EQUIPMENT (FOR PPI USE ONLY) PPI PayMover: 1 Equipment Leasing Option - First Data Global Leasing Lease Term: mos. Annual Tax Handling Fee: $10.20 Total Monthly Lease Charge: $ wio taxes, late fees, or other charges that may apply - See Lease Agreement in Program Guide for details. This is a non-cancelable lease for the full term indicated. © 2010 All rights reserved. Payment Processing, Inc., is a registered ISO/MSP for Wells Fargo, N.A., Walnut Creek, CA. All trademarks, services marks and trade name referenced in this material are the property of their respective owners. Payment Processing, inc. + 8209 Central Ave. Newark CA 94560 + (Ph) 800-774-6462 (Fax} 800-391-3775 Email: SclutionPros@paypres.cor ppi0910 www.payoros.com Page 1 of 2 | SCHEDULE A= CREDIT/DEBIT CARD SERVICES AND FEE SCHEDUEE ANNUAL OR PROJECTED ANNUAL VISA/MASTERCARD VOLUME: [AVERAGE OR PROJECTED AVERAGE CREDIT CARD TICKET: | QUALIFIED CATEGORY " [NETWORK : $235.800 $372.00 Moto/internet (CNP/Merit |) | FirstData PPI PayMover we : =|ADDINIONAE SERVICES pees : 3-Tier RATES (Enter your existing account numbers or mark the services you would like to accept, ) MID NON PER PER SERVICE QUALIFIED QUALIFIED | QUALIFIED ITEM SERVICE RATE/FEE ITEM NUMBER VISA CREDIT 2.250% 2.250 %! 2.250 %| $0.000 JAMEX D EXISTING VISA DEBIT %| %| % PIN DEBIT" | GQ ACCEPT $0.2 MASTERCARD CREDIT 2.250 %| 2.250 %! 2.250 %| $0.000 JEST OG ACCEPT MASTERCARD DEBIT % % %! DAILY DISCOUNT] O ACCEPT. NIA NIA DISCOVER CREDIT 2.250 % 2.250 %| 2.250 %| $0.000 DISCOVER DEBIT % %| %| Mid-Qualified transactions are generally non-swiped domestic transactions containing the appropriate Address Verification data, or corporate transactions containing the appropriate enhanced data, which are settled with 48 hours. Non-Qualified transactions are generally transactions that do not fall into the above Qualified or Mid-Qualified category. “Additional network fees charged by individual debit networks will be passed through to merchant; pin-pad equipment required. “EBB - Transactions not qualifying at the Qualified Category will be assessed a downgrade |““"IPT (Interchange Pass-through - All transactions will be billed at pass-through of rate of % plus pass-through of interchange according to Visa and MasterCard rules and]interchange and assessments rates as determined by Visa/MasterCard/Discover. The Qualified Discount Rate above will be charged on all transactions. regulations. ai Assocation fees for Services set forth in this Agreement will be passed through to you to reflect all our costs associated with any charges by third parties for online communications cross-border transactions. and similar items. Association Assessment Fees OFHER. FEES. & SERVICES FEE FEE $0.00 {BATCH SETTLEMENT $0.000}VISA TERMINAL AUTHORIZATION $1.50 | VOICE AUTHORIZATION $0.000|MASTERCARD TERMINAL AUTHORIZATION $0.00 |ADDRESS VERIFICATION $0.000{DISCOVER TERMINAL AUTHORIZATION $0.00 {MONTHLY STATEMENT $0.200 |NON BANK CARD TERMINAL AUTHORIZATION $25.00 [MINIMUM DISCOUNT $0.00 ANNUAL FEE $15.00 |CHARGEBACK $0.00 [eINVOICE MONTHLY SERVICE FEE $25.00 ]ACH REJECT $0.000{OTHER: $0.00 [APPLICATION FEE $0.00 ]OTHER: MONTHLY GIFT SERVICE FEE $0.00 {ONLINE REPORTING ¥ |ACCEPT DECLINE AMERICAN EXPRESS DISCOUNT RATE % OR L} FLAT MONTHLY FEE $7.95 RETAIL $0.10 TRANS FEE + 0.30% CNP DOWNGRADE OR ANNUAL VOLUME I JAVERAGE TICKET | O SERVICES. WHOLESALE & ALL OTHER $0.15 TRANS FEE PAY FREQUENCY Sa (Choose One) [1] 3 Day 15Day_ _() 30 Dav LI MONTHLY GROSS PAY (+.03% IF $100k +) OR LJ DAILY GROSS PAY [ACCEPTANCE OF 11 CONDITIONS [MERCHANT : By signing below, | enresent — have read and am authorized to sign and submit this Application on behalf of the entity above and all information | have provided herein is true. complete, and accurate. | authorize American Express Travel Related Services Company, Inc. (‘American Express’) to verify the information in this Application and receive and exchange information about me personally, including by requesting reports from consumer reporting agencies. | authorize and direct American Express to inform me directly, or through the entity above, of reports about me that American Express has requested from consumer reporting agencies. Such information will include the name and address of the agency furnishing the report. | understand that upon American Express’ approval of the entity indicated above to accept the American Express Card. the terms and conditions for American Express® Card Acceptance (“Terms and Conditions’) will be sent to such entity along with a Welcome Letter. By accepting the American Express Card for the purchase of goods and/or services, or otherwise indicating its intention to be bound, the entity agrees to be bound by the Terms and Conditions. Merchant certifies that all information set forth in this completed Merchant Application and Agreement (Agreement) is true and correct and that Merchant has received a copy of the Terms and Conditions, Operating Procedures and Confirmation Page, all of which is part of the Agreement, and by this reference incorported herein. Merchant further agrees that Merchant will not accept more than 20% of its card transactions via mail, telephone or Internet order. However, if your Agreement is approved based upon contrary information stated in the Agreement, you are authorized to accept transactions in accordance with the percentages indicated in the appropriate section. This signature page also serves as a signature page to the Equipment Lease Agreement, if selected, the undersigned Merchant being the “Lessee” for purposes of such Equipment Lease Agreement. Merchant authorizes Payment Processing, Inc. (“PPI") and Wells Fargo Bank, N.A. ("Bank") and their agents to investigate the references, statements and other data contained herein and to obtain additional information from credit bureaus and other lawful sources, including persons and companies named in this Agreement. Merchant authorizes PPI, and Bank and their agents (a) to procure} information from any consumer reporting agency bearing his/her personal credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. and (b) to contact all previous employers, personal references and educational institutions. It is our policy to obtain certain information in order to verify your identity while processing your Agreement. The individual who signs this Agreement has authority to do so and to bind its establishment to the terms and conditions of the Agreement.Merchant agree: to all the terms of the Agreement. The Agreement shall not take effect until Merchant has been approved and this Agreement has been accepted by PPI and Bank. Business Legal Name Merchant's Business Principal/Officer's Signature X Signature X Title Date Title Date Print Name of Signer Print Name of Signer As a primary inducement to Bank/PPT and/or FOMS. if applicable. to enter into this Agreement and/or Lease Agreement and any addendum, or attachment thereto, with Merchant, the undersigned Guarantor(s), by signing this Agreement and any addendum or attachment thereto, jointly and severally, unconditionally and irrevocably, guarantee the continuing full and faithful performance and payment by Merchant of each of its duties and obligations to Bank/PPI and/or FDMS, if applicable, pursuant to this Agreement and/or Lease Agreement, as it now exists or as it may be amended from time to time, whether before or after termination or expiration and whether or not Guarantor has received notice of any amendment. If Merchant} breaches its Agreement and/or Lease Agreement, Bank/PPI and/or FOMS, as applicable. may proceed directly against Guarantor or any other person or entity responsible for the performance of the Agreement and/or Lease Agreement. without first exhausting their remedies against any other person or entity responsible therefore to them, or any security held by Bank. Personal Guarantee(s) Signature X Signature X Print Name of Signer Print Name of Signer THIS MERCHANT PROCESSING APPLICATION AND AGREEMENT HAS BEEN EXECUTED ON BEHALF OF AND BY THE AUTHORIZED MANAGEMENT OF MERCHANT AS OF THE EFFECTIVE DATE——_\ Accepted nS Pros ing, Wells Fargo Bank, N.A., 1200 Montego Way, Walnut Creek, CA 94598 lie 9 Signature Title John E. ged}! Sr AEP IPED: £ Title Date © 2010 Afl rights feserved. Payment Processing. Inc.. is a registered iSO/MSP for Wells Fargo, N.A.. Walnut Creek. CA. All trademarks, services marks and trade name referenced in this material are the property of their respective owners. Payment Processing, Inc. * 8200 Central Ave. Newark CA 94560 » (Ph) 800-774-6462 (Fax) 800-891-8775 Email: SolutionPros@paypros.com p10910 ww'w.paypros.com Page 2 of 2 >) Payment Processing INCORPORATED Voided Check Form Staple Voided Check Here Please staple a voided check from your business checking account to this sheet. Your application cannot be processed without an imprinted voided check. (Starter Checks, Deposit Slips or Spec Sheets are not acceptable...) (Business Name & Address must be imprinted on the checks and match exactly as Corporate or DBA Info on the application or a bank letter will be required! The bank letter must be on a bank letter head, and