ACCOUNT SETUP FORM. Page 1 of 2 NATIONAL MERCHANTS ASSOCIATION

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1 ACCOUNT SETUP FORM Required with every application. Please Submit to your ProAgent Portal. Merchant DBA Agent ID Business Type: Retail Restaurant QSR/Small Ticket Lodging Supermarket EQUIPMENT INFORMATION Equipment Placement Program 1 Reprogram Lease 2 Purchase (For Purchase Only) Product Quantity Cost Product Quantity Cost Product Quantity Cost Product Quantity Cost Total Cost 1. Equipment Program document required 2. Leasing document required upon submission TERMINAL DETAILS IP Default Custom Dial Up* EMV PIN Debit (25 encryption fee) EMV Tip Line With Adjust Clerks/Servers Mode NFC Internal NFC Tip Prompt Multi Merchant *If Dial up: PBX# External EBT Invoice# Fleet Card Snap ID# Cashback Auto Batch: (If unchecked will default to PST 2:55 pm ) Yes Time No Batch Report: Total Detailed POS DETAILS POS System Software Version Additional Software Additional Hardware POS Fee (Monthly) GATEWAY DETAILS NMA Membership Required For Gateway Billing New Existing Deployed By: Agent NMA Gateway Monthly Fee Gateway Transaction Fee NMI Authorize.net Other Gateway Setup Fee Miscellaneous Fee Existing Gift/Loyalty Program Name of Company Used Wireless Monthly Fee Wireless Transaction Fee Wireless Setup Fee Page 1 of 2

2 ACCOUNT SETUP FORM PAYMENT INFORMATION Bill To: ISO/Agent Merchant Residuals ACH* Credit Card* *Requires Additional Authorization Form ACH* Credit Card* SHIPPING INFORMATION Ship To: ISO/Agent Merchant Other Name (For tracking info) Address City State Zip Shipping Method: Standard Next Day* Overnight* *Additional shipping fees will apply for Next Day and Overnight SPECIAL REQUESTS (Requests only; require approval) Billing Schedule: Monthly* Daily Next Day Funding* Notes:* *Restrictions May Apply Your signature confirms your approval and acceptance of the terms and fees listed above. These fees will be paid in accordance with your Merchant Processing Application and Merchant Processing Agreement. NMA has the right to increase these fees if vendors increase costs for NMA. NMA will only increase the fees equal to the cost increase by vendors. Signature Page 2 of 2

3 Rev: 2017-B 1. BUSINESS INFORMATION Federal Tax ID Business Start Date Name of Account (DBA) Name of Account (Legal Name) Address (No PO Box) Address City State Zip City State Zip DBA Phone Number Website DBA Address Customer Service Phone Number Mail To: DBA Legal Fax Number 2. MERCHANT PROFILE Type of Ownership: Sole Proprietorship Partnership Limited Liability Company (LLC) Public Corporation Private Corporation Not for Profit (501c) State Filed Business Type: Retail Mail/Telephone Internet/eCommerce Restaurant Other: Seasonal Sales: Yes High Volume Months Dollar Volume One Time Event: Yes Date(s) Describe Goods/Services Sold When are goods/services delivered? Within 1 day 1 week 30 days Other: 3. BANK DISCLOSURE Merchant Bank (Acquirer) Information: Commercial Bank of California, MacArthur Blvd., Suite 100, Irvine, CA Important Merchant Bank Responsibilities: A Card Brand member is the only entity approved to extend acceptance of Card Brand products directly to a merchant. A Card Brand member must be a principal party to the Merchant Processing Agreement. The Card Brand member is responsible for, and must provide settlement funds to, the merchant. The Card Brand member is responsible for all funds held in reserve that are derived from settlement. The Card Brand member is responsible for educating merchants on pertinent Card Brand Rules with which merchants must comply. Important Merchant Responsibilities: Ensure compliance with cardholder data security and storage requirements. Maintain fraud and chargebacks below thresholds. Review understand and comply with the terms of the Merchant Processing Agreement. Comply with Card Brand Rules. The responsibilities listed above do not supersede terms of the Merchant Processing Agreement and are provided to ensure the Merchant understands important obligations of each party. In the event that any term in either the Merchant Processing Application or Merchant Processing Agreement conflicts with a term in the Merchant Marketing and Processing Agreement between Commercial Bank of California and National Merchants Association, the terms of the Merchant Marketing and Processing Agreement shall control. Authorized Signature Date Page 1 of 6

4 4. OWNERS/OFFICERS (All owners with 25 or more ownership) Name 1 (Legal Name) Ownership Percentage Title Name 2 (Legal Name) Ownership Percentage Title Home Address Home Address City State Zip City State Zip Phone Number D.O.B. Phone Number D.O.B. Driver s License Number/State Social Security Number Driver s License Number/State Social Security Number 5. BANKING INFORMATION Bank Name Contact Phone Number Transit Routing Number/ABA Number Account Number AUTHORIZATION FOR AUTOMATIC FUNDS TRANSFER (ACH): The Merchant Bank (identified on page 1) is authorized to initiate or transmit automatic credit and/or debit and/or check entries to the Settlement Bank indicated and/or to the account identified in the attached voided check for all services contemplated under the Merchant Processing Agreement. Said authority is granted to Merchant Bank s processor and their agent. 6. TRANSACTION INFORMATION Gross Annual Sales Volume (Cash + Credit + Debit + Check) Average Annual American Express Volume Average Annual Volume Collected: Avg MC/Visa/ Disc Ticket Daily Monthly Avg Amex Ticket Highest Ticket Amount Where is the sale transacted? Store Front Internet Mail Order Telephone Order = MERCHANT SITE SURVEY 1. Is the merchant s DBA name displayed at the facility? Window Store Front Door N/A Other 2. Does the address match that of the merchant s application? Yes No If no, explain 3. Does the merchant have appropriate/sufficient equipment/inventory consistent with the type of business and projected sales volume and average ticket? Yes No If no, explain 4. Does the merchant: Own Lease Other 5. Is proper license visible? Yes No If no, explain 6. Are customers required to leave a deposit? Yes No Percentage of deposit required 7. Return Policy: Full Refund Exchange Only None 8. Does merchant have a refund policy for MC/Visa/Discover/Amex Sales? Yes No If yes, check one: Exchange Store Credit MC/Visa/Disc/Amex Credit Section 7 continued on Page 3 Page 2 of 6

5 7. MERCHANT SITE SURVEY (Continued) 9. If MC/V/Disc/Amex Credit, within how many days does merchant submit credit transactions? 0-3 days 4-7 days 8-14 days Over Does any of merchant s cardholder billings involve automatic renewals or recurring transactions? Yes No 11. Is the merchant PCI Compliant? Yes No Name Signature Date 8. CARD NOT PRESENT INFORMATION Only for merchants who process more than 50 of their bankcard transactions, or volume, without physically swiping the credit card. 12. When do you typically charge the cardholder? Before or After the product/service is provided to the cardholder (check one) 13. What is your general breakdown of billing? At time of purchase Monthly Other Explain 14. What is the average amount of time (in days) that will take for the cardholder to receive the product/service? 15. What is your target geographical area? United States Other Canada Explain Quarterly Amount of days Annually 16. For your product/service, do you outsource any of the following? Customer Service Product Shipment Handling of Returns Cardholder Billing Fulfillment House 17. If yes to any of the above fulfillment organizations, please provide a copy of the agreement. 9. SERVICE FEE SCHEDULE Pass Through Interchange Qual Credit Qual Debit American Express Qual credit Tiered Debit Qual Debit Mid Qual Debit Non Qual Credit Qual Credit Mid Qual Credit Non Qual Amex Opt Blue Qual Amex Opt Blue Mid Qual Amex Opt Blue Non Qual MC Worldcard Qual MC Worldcard Mid Qual MC Worldcard Non Qual Visa Rewards 1 Visa Rewards 2 Section 9 continued on Page 4 Page 3 of 6

6 9. SERVICE FEE SCHEDULE (Continued) ERR Qual Credit American Express Qual Credit Billback Billback Qual Debit Billback 10. PIN DEBIT FEE SCHEDULE Pass Through Pin Debit Network Fees Pin Debit Rate Pin Debit Transaction Per Item Pin Debit Set Up Fee (One Time) 11. EBT EBT Rate EBT Transaction Per Item EBT Set Up Fee (One Time) 12. SURCHARGE FEE SCHEDULE Surcharge Credit Card Surcharge Amount Surcharge Monthly Fee Merchant is responsible for all processing fees on Card transactions. If Merchant does not apply a Surcharge to a Card transaction, the Merchant is still responsible for the associated processing fees. As a Surcharge Merchant, you agree to post signage as required by the Card Organizations or Settlor that informs Cardholders and/or customers of the Merchant Surcharge policy. The signage shall be placed at the entry point of the store and at the point of sale. When conducting an ecommerce transaction, the surcharge disclosure shall appear on the first page that references credit card brands and shall include the of the surcharge on credit card transactions. 13. AUTHORIZATION AND CAPTURE FEES MasterCard/Visa Authorization & Capture Fee Discover Network Authorization & Capture Fee American Express Authorization & Capture Fee Page 4 of 6

7 14. MISCELLANEOUS FEES Chargeback Fee (Per Item) AVS Fee (Per Item) PCI Non-Compliance Fee Online Statement Retrieval Fee (Per Item) Account On File Fee (Monthly) Return Txn Fee (Per Item) Paper Statement Monthly Minimum Dispute Manager (Monthly) Sales Txn Fee (Per Item) Online Reporting (Monthly) Batch Fee (Per Item) PCI Compliance Fee Bank Reject Fee (Per Item)...Currently Voice Authorization Fee...Currently 1.75 ARU Fee...Currently 1.75 PULSE* Pulse Debit Network Annual Fee...Currently STAR* STAR Debit Network Annual Fee....Currently NYCE* Nyce Debit Network Annual Fee...Currently ACCEL/EXCHANGE* Accel/Exchange Debit Network Annual Fee...Currently VISA* Acquirer Processing Fee...Currently per authorization. International Fee (IAF)...Currently or 0.99 per settled transaction based on your merchant category code. ISA Fee...Currently of Visa International Sales Volume. Cash Advance Fee (ISA)...Currently of Visa International Sales Volume. Misuse of Auth Fee...Currently per authorization. Zero Floor Limit Fee...Currently per Visa transaction without proper authorization. Transaction Integrity Fee...Currently per transaction. Credit and Debit Assessment Fee...Currently of sales volume. Network Fee CP (Card Present)...Varies based on # of locations. Network Fee CNP (Card Not Present)...Varies based on CNP volume. Rates and fees are based on proposed volume of transactions listed in Merchant s application and above, and corresponding levels of interchange applicable thereto, and are subject to adjustment by Merchant Bank or Card Associations based upon actual volume levels and qualifications for interchange. Early Termination Fee is: (only one may be selected) Unrestricted Merchant. A fixed fee of or Restricted Merchant (See the Merchant Processing Agreement for the calculation). If Merchant elects an option other than All Cards but later submits a transaction in another category, Merchant Bank will process the transaction pursuant to the terms of this Merchant Processing Application and assess the appropriate fee. ***Network Fees may apply to certain Merchants assessing a convenience fee. *Pricing may increase due to any increases in association and other third party fees, which will be passed through to you. MASTERCARD * Network Access Usage Fee...Currently per transaction. Cross-Border Fee...Currently of MasterCard International Sales Volume. Acquirers Program Support Fee...Currently of MasterCard International Sales Volume. Acquirer Brand Volume Fee...Currently of sales volume. (An additional fee will be added for transactions>=1,000.currently0.02). Acct Status Inq SVC Intraregional per transaction. Acct Status Inq SVC Interregional per transaction. Processing Integrity Fee per authorization Digital Enablement Fee...Currently of MasterCard Card Not Present Sales Volume. (That is not cleared or reversed). Global Wholesale Travel B2B Fee Annual Merchant Location Fee Annual Payment Facilitator Merchant Location Fee DISCOVER * Data Usage Fee...Currently per transaction. International Processing Fee...Currently per settled international transaction. International Service Fee...Currently per settled international transaction. Assessment Fee...Currently of sales volume. AMERICAN EXPRESS * Network Fee...Currently per sales transaction. Non-Swiped Transaction Fee...Currently per non-swiped sales transaction. Inbound Fee...Currently per international sales transaction. Page 5 of 6

8 15. PERSONAL GUARANTY Name of Guarantor: Merchant Name: To Induce Commercial Bank of California ( Merchant Bank ), National Merchants Association, and all other third-party providers to enter into the Merchant Processing Agreement, the Guarantor(s) indicated below 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 Merchant Bank pursuant to the Merchant Processing Agreement, as it now exists or as amended from time to time, with or without notice. This guaranty is a guaranty of payment, and not of collection, and a debt of Guarantor for his or her own account. Accordingly, Merchant Bank shall not be required before enforcing this guaranty against Guarantor: (1) to pursue any right or remedy Merchant Bank may have against Merchant or any other Guarantor; (2) to make any claim in a liquidation or bankruptcy of Merchant or any other Guarantor of these obligations; or (3) to make demand of the Merchant or any other Guarantor of these obligations or to seek to enforce or realize upon any collateral security held by Merchant Bank which may secure these obligations. The guaranty shall not be discharged or otherwise affected by any waiver, indulgence, compromise, settlement, extension of credit, or variation of terms of the Merchant Processing Agreement. I/We waive agree to promptly provide to Merchant Bank any information requested from time to time concerning my/our financial condition, business history, business relationships and employment information. This guaranty will not be discharged or affected by the death of the Guarantors, will bind all heirs, administrators, representatives and assigns and may be enforced by or for the benefit of any successor of Merchant Bank. Guarantor(s) understand that the inducement to the Guaranty Recipients to enter into the Merchant Processing Agreement is consideration for the guaranty, and that this guaranty remains in full force and effect even if the Guarantor(s) receive no additional benefit from the guaranty. Signature of Guarantor, as an individual Printed Name and Home Address of Guarantor 16. MERCHANT AUTHORIZATION AND ACCEPTANCE The owner, officer, partner, or member signing this Merchant Processing Application (the Signing Party ) represents that the Signing Party is authorized to sign the Merchant Processing Application and thereby enter into the Merchant Processing Agreement. The Signing Party also represents and warrants that this Merchant Processing Application and all information and documentation submitted in connection with the Merchant Processing Agreement is true, complete and correct. All requested information must be provided for this Merchant Processing Application to be processed. If the information provided on this Merchant Processing Application or elsewhere cannot be verified, then this Merchant Processing Application may be denied. Merchant and its owner have authorized, and shall continue to authorize Merchant Bank, its third-party providers and their representatives and affiliates to obtain and verify any financial and credit information regarding Merchant and its owner, and to share such information amongst Merchant Bank, its third-party providers and their affiliates and their representatives. Notice: To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who enters into a Merchant Processing Agreement. This means that when you sign this Merchant Processing Application and enter into the Merchant Processing Agreement we will ask for name, address, date of birth and other information that will allow us to identify you or the entity on whose behalf you are signing. MERCHANT HAS READ AND UNDERSTANDS ALL OF THE TERMS OF THE MERCHANT PROCESSING AGREEMENT SET FORTH ON THE WEBSITE AND ACCEPTS AND AGREES WITH ALL SUCH TERMS. THIS MERCHANT PROCESSING APPLICATION IS INCORPORATED BY REFERENCE IN TOTAL TO THE MERCHANT PROCESSING AGREEMENT. IF MERCHANT BANK AGREES TO PROVIDE SERVICES TO MERCHANT, SUBMISSION OF ANY TRANSACTIONS OR ITEMS TO MERCHANT BANK OR ITS THIRD-PARTY PROVIDERS (INCLUDING ) CONSTITUTES CONSENT TO THE MERCHANT PROCESSING AGREEMENT TERMS AND CONDITIONS AND THE TERMS AND CONDITIONS RELATED TO ANY OTHER SERVICES MERCHANT HAS ELECTED TO RECEIVE. THE INITIAL TERM OF THE MERCHANT PROCESSING AGREEMENT IS THREE YEARS AND MERCHANT WILL BE RESPONSIBLE FOR AN EARLY TERMINATION FEE AS DESCRIBED IN THE MERCHANT PROCESSING AGREEMENT FOR TERMINATING THIS AGREEMENT OR DISCONTINUING PROCESSING. Authorized Signature Telephone Name (Please Print) Fax Title Date Page 6 of 6