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Client certifies that all information set forth in this completed Merchant Processing Application is
true and correct and that Client has received a copy of the Program Guide and Confirmation Page,
which is part of this Merchant Processing Application (consisting of Sections 1-9), and by this
reference incorporated herein. Client acknowledges and agrees that we, our Affiliates and our third
party subcontractors and/or agents may use automatic telephone dialing systems to contact Client at
the telephone number(s) Client has provided in this Merchant Processing Application and/or may leave
a detailed voice message in the event that Client is unable to be reached, even if the number
provided is a cellular or wireless number or if Client has previously registered on a Do Not Call
list or requested not to be contacted Client for solicitation purposes. Client hereby consents to
receiving commercial electronic mail messages from us, our Affiliates and our third party
subcontractors and/or agents from time to time. Client further agrees that Client will not accept
more than 20% of its card transactions via mail, telephone or Internet order. However, if your
Application is approved based upon contrary information stated in Section 5, Transaction Information
section above, you are authorized to accept transactions in accordance with the percentages
Indicated In that section. This signature page also serves as a signature page to the TeleCheck
Solutions Agreement appearing In the Third Party Section of the Program Guide, if selected, the
undersigned Client being “You” and “Your” for the purposes of the TeleCheck Solutions Agreement.
On behalf of myself as an Individual, the entity on whose behalf | am signing, and Its principals
(collectively, the Client Parties),(A) | authorize Processor, Servicers, the applicable Payment
Networks, and its and their Affiliates, third party subcontractors, service providers, and/or
agents: (i) to use, disclose, and exchange amongst them and externally with other third-parties, the
information in the Agreement and information about each of the Client Parties, (including by
requesting and sharing, personal and business consumer reports, bank references, and other
information as necessary from time to time), for marketing and administrative purposes, verification
purposes under the Merchant Processing Application and Agreement (MPA), if approved, product
improvement, fraud, analytics and any other purposes permitted by law fang to continue to use and
share such information following the termination of this Agreement); (ii) to inform me directly
about the contents of requested consumer reports (Including the name and address of the agency
furnishing the report), and (ll) to receive any and all personal and business credit financial
Information from all references, including banks and consumer reporting agencies, which are hereby
released to provide that information; and (B) | certify that: (i) The federal taxpayer
identification number and corresponding filing name provided herein are correct; (ii) The statements
made and agreed to in this MPA, to which | have not made any alterations or stricken out any
language, are true, complete and accurate, and may be relied upon as current unless changed or
updated per the Notice provisions of Agreement; (lll) | can read and understand the English
language; (iv) | have received and read a copy of the (a) MPA (consisting of Sections 1-9), (b)
Program Guide, (c) Confirmation Page {version N_WF_R_2605), and (v) | have authority to bind the
entity on whose behalf | am signing below and have the appropriate consents and authority from each
of the Client Parties (whether Individuals or other entities) to authorize the use and sharing of
data described above. Processor’s privacy notice Is available at www. flsorv.com/privacy. Client
authorizes FDMS and Bank and their affiliates to debit Client's designated bank account via
Automated Clearing House (ACH) for costs associated with equipment hardware, software and
shipping.
You further acknowledge and agree that you will not use your merchant account and/or the Services
for illegal transactions, for example, those prohibited by the Unlawful Internet Gambling
Enforcement Act, 31 U.S.C. Section 5361 et seq, as may be amended from time to time, or processing
and acceptance of transactions In certain jurisdictions pursuant to 31 CFR Part 500 et seq. and
other laws enforced by the Office of Foreign Assets Control (OFAC). To help the government fight the
funding of terrorism and money laundering activities, Servicers obtain, verify, and record certain
Information Including your full name, physical address, and any other Information needed for
identity verification purposes while processing this MPA, as described in the USA Patriot Act.
Client certifies, under penalties of perjury, that the federal taxpayer Identification number
and corresponding filing name provided herein are correct. Client agrees to all the terms of
this Merchant Processing Application and Agreement. This Merchant Processing Application and
Agreement will not take effect until Client has been approved and this Agreement has been
accepted by Processor and Bank. Acceptance by Processor and Bank will occur upon the earlier of
the execution of this Merchant Processing Application and Agreement by Processor and Bank, or
the commencement of the provision of the Services by Processor and Bank.
Client's Business Principal/Officer:
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