THIS IS A SAMPLE STATEMENT YOUR CARD PROCESSING STATEMENT 099382/000001/187698/0001/23882/0000/144030 000 01 000000 Page 1 of 8 THIS IS NOT A BILL This is the overall summary of the account activity for the current statement period. This is your Merchant Number which will identify you to your provider. SUMMARY Page 3 An overview of account activity for the statement period. Fees charged for September activity will appear on October statement. Amount $33,075.63 Third Party $8,833.50 Chargebacks/Reversals 0.00 Adjustments 0.00 Fees Charged* -$505.20 Amount Funded to Your Bank $23,736.93 See page 2 for Key Definition of Terms *Fees Charged Summary Includes Interchange Charges (IC), Service Charges (SC) and Fees All amounts shown are in U.S. funds (Amount - Third Party) + Chargebacks/Reversals + Adjustments + Fees Charged = Amount Funded This is the total amount of sales submitted for all cards This is the amount of sales submitted for American Express Cards. This is the amount of fees charged to your checking account for the previous month. IMPORTANT INFORMATION ABOUT YOUR ACCOUNT Please note that important messages may continue or appear on the third page of this merchant statement. Review the third page of this statement for any continued or additional messages. 099382/000001/187698/0001/23882/0000/144030 000 01 000000
Page 2 of 8 Interchange Charges will remain the same regardless of your Merchant Service Provider. Key Card Processing Terms in Plain Language Amount You - The total dollar amount of card transactions submitted and processed during the Statement Period. Third-Party - These are transactions that are passed directly to third party service providers for processing and/or funding. Common third-parties r ies include American Express and Discover. Chargebacks/Reversals - Those transactions that are challenged or disputed by a cardholder or card-issuing bank. A Chargeback equals the transaction amount that is disputed by the cardholder or card-issuing bank. A Reversal is the amount that was initially resolved against the merchant, but has subsequently been resolved in favor of the merchant. Adjustments - The amounts credited to, or deducted from, your account to resolve processing and billing discrepancies. Service Charges are dependent on your Merchant Service Provider and this is where Orbis will save you Money. Interchange Charges - These are the variable fees es charged by Card Organizations for processing transactions. Factors that affect f Interchange Charges include card type, information contained in the transaction, and how/when when the transaction was processed. Service Charges - Also known as Discount Rate; the amounts charged to authorize, process and settle card transactions. Fees - The range of transaction-based and/or fixed amounts charged for specific card processing services. Amount Funded to Your Bank - The total dollar amount of credited/paid to your account transactions during the Statement Period. - The unique account number assigned to every merchant and merchant location. You ll find it at the top of your statement. 099382/000001/187698/0001/23882/0000/144031 000 02
This is your summary of sales submitted for each card type. Page 3 of 8 SUMMARY BY CARD TYPE ( Sales You - Refunds = Amount You ) Card Type Gross Sales You Refunds Amount You Average Ticket Items Amount Items Amount Items Amount MasterCard $175.69 43 $7,264.88 2 $61.56 41 $7,203.32 Visa $138.53 123 $17,038.81 0 0.00 123 $17,038.81 Discover 0.00 0 0.00 0 0.00 0 0.00 Diners 0.00 0 0.00 0 0.00 0 0.00 JCB 0.00 0 0.00 0 0.00 0 0.00 American Express $252.39 35 $8,833.50 0 0.00 35 $8,833.50 201 $33,137.19 2 $61.56 199 $33,075.63 (Amount - Third Party) + Chargebacks/Reversals + Adjustments + Fees Charged = Amount Funded AMOUNTS FUNDED BY BATCH Number Amount Third Party Chargebacks/ Reversals Adjustments Fees Charged* Funded Funded Amount 09/01/12 $1,531.17 $363.73 0.00 0.00 0.00 $1,167.44 09/02/12 $853.23 $162.00 0.00 0.00 -$505.20 $186.03 09/03/12 $2,903.53 $371.51 0.00 0.00 0.00 $2,532.02 09/04/12 $136.08 0.00 0.00 0.00 0.00 $136.08 Last months 09/05/12 $213.00 0.00 0.00 0.00 0.00 $213.00 09/06/12 $498.29 $73.21 0.00 0.00 0.00 fees charged $425.08 09/07/12 $1,133.09 $741.59 0.00 0.00 0.00 $391.50 this month 09/08/12 $581.52 0.00 0.00 0.00 0.00 $581.52 09/09/12 $211.03 $84.67 0.00 0.00 0.00 $126.36 09/10/12 $656.22 $151.08 0.00 0.00 0.00 $505.14 09/11/12 $1,753.92 $910.44 0.00 0.00 0.00 $843.48 09/13/12 $4,192.71 $4,192.71 0.00 0.00 0.00 0.00 09/14/12 $275.34 $64.26 0.00 0.00 0.00 $211.08 09/15/12 $517.86 0.00 0.00 0.00 0.00 $517.86 09/16/12 $3,068.17 $364.24 0.00 0.00 0.00 $2,703.93 09/17/12 $214.26 $214.26 0.00 0.00 0.00 0.00 09/18/12 $0.01 0.00 0.00 0.00 0.00 $0.01 09/19/12 $2,263.75 $289.04 0.00 0.00 0.00 $1,974.71 09/20/12 $258.88 $258.88 0.00 0.00 0.00 0.00 09/25/12 $7,822.91 $45.00 0.00 0.00 0.00 $7,777.91 09/27/12 $424.31 $60.59 0.00 0.00 0.00 $363.72 09/28/12 $456.07 $187.66 0.00 0.00 0.00 $268.41 09/29/12 $2,752.44 $211.68 0.00 0.00 0.00 $2,540.76 09/30/12 $357.84 $86.95 0.00 0.00 0.00 $270.89 $33,075.63 $8,833.50 0.00 0.00 -$505.20 $23,736.93 AMOUNTS SUBMITTEDBY BATCH *Certain fees and charges may relate to a prior period MasterCard Visa Discover Diners American Express 09/01/12 001001005186 $238.56 $928.88 0.00 0.00 $363.73 $1,531.17 09/02/12 001001003695 0.00 $691.23 0.00 0.00 $162.00 $853.23 09/03/12 001001002285 $655.69 $1,876.33 0.00 0.00 $371.51 $2,903.53 09/04/12 001001002153 $136.08 0.00 0.00 0.00 0.00 $136.08 099382/000001/187698/0001/23882/0000/144032 000 03
Page 4 of 8 AMOUNTS SUBMITTEDBY BATCH MasterCard Visa Discover Diners American Express 09/04/12 193104006169 0.00 $213.00 0.00 0.00 0.00 $213.00 09/05/12 194104006213 0.00 $82.11 0.00 0.00 $73.21 $155.32 09/06/12 001001004733 0.00 $342.97 0.00 0.00 0.00 $342.97 09/06/12 195104006190 0.00 $391.50 0.00 0.00 $741.59 $1,133.09 09/08/12 001001004932 $130.56 $450.96 0.00 0.00 0.00 $581.52 09/09/12 001001003714 $45.36 $81.00 0.00 0.00 $84.67 $211.03 09/10/12 001001002219 $103.68 $401.46 0.00 0.00 $151.08 $656.22 09/11/12 001001004480 $78.84 $764.64 0.00 0.00 $910.44 $1,753.92 09/13/12 001001004687 0.00 0.00 0.00 0.00 $4,192.71 $4,192.71 09/13/12 196104006138 0.00 $211.08 0.00 0.00 $64.26 $275.34 09/14/12 197104005745 0.00 $64.26 0.00 0.00 0.00 $64.26 09/15/12 001001004973 $405.00 $48.60 0.00 0.00 0.00 $453.60 09/15/12 198104004227 0.00 $474.13 0.00 0.00 $191.44 $665.57 09/16/12 001001003766 $634.25 $1,595.55 0.00 0.00 $172.80 $2,402.60 09/16/12 199104002651 0.00 0.00 0.00 0.00 $214.26 $214.26 09/18/12 001001004402 $0.01 0.00 0.00 0.00 0.00 $0.01 09/18/12 200104006009 0.00 $395.57 0.00 0.00 0.00 $395.57 09/19/12 001001004513 $444.79 $1,134.35 0.00 0.00 $289.04 $1,868.18 09/19/12 201104006110 0.00 0.00 0.00 0.00 $258.88 $258.88 09/24/12 202104005677 0.00 $1,278.60 0.00 0.00 0.00 $1,278.60 09/25/12 001001004370 $4,093.43 $2,405.88 0.00 0.00 $45.00 $6,544.31 09/26/12 203104005870 $237.07 $126.65 0.00 0.00 $60.59 $424.31 09/27/12 204104006000 0.00 $268.41 0.00 0.00 $187.66 $456.07 09/29/12 001001004919 0.00 $2,540.76 0.00 0.00 $211.68 $2,752.44 09/30/12 001001003648 0.00 $270.89 0.00 0.00 $86.95 $357.84 Sub s $7,203.32 $17,038.81 0.00 0.00 $8,833.50 $33,075.63 JCB 09/01/12 001001005186 0.00 0.00 09/02/12 001001003695 0.00 0.00 09/03/12 001001002285 0.00 0.00 09/04/12 001001002153 0.00 0.00 09/04/12 193104006169 0.00 0.00 09/05/12 194104006213 0.00 0.00 09/06/12 001001004733 0.00 0.00 09/06/12 195104006190 0.00 0.00 09/08/12 001001004932 0.00 0.00 09/09/12 001001003714 0.00 0.00 09/10/12 001001002219 0.00 0.00 09/11/12 001001004480 0.00 0.00 09/13/12 001001004687 0.00 0.00 09/13/12 196104006138 0.00 0.00 09/14/12 197104005745 0.00 0.00 09/15/12 001001004973 0.00 0.00 099382/000001/187698/0001/23882/0000/144033 000 04
Page 5 of 8 AMOUNTS SUBMITTEDBY BATCH JCB 09/15/12 198104004227 0.00 0.00 09/16/12 001001003766 0.00 0.00 09/16/12 199104002651 0.00 0.00 09/18/12 001001004402 0.00 0.00 09/18/12 200104006009 0.00 0.00 09/19/12 001001004513 0.00 0.00 09/19/12 201104006110 0.00 0.00 09/24/12 202104005677 0.00 0.00 09/25/12 001001004370 0.00 0.00 09/26/12 203104005870 0.00 0.00 09/27/12 204104006000 0.00 0.00 09/29/12 001001004919 0.00 0.00 09/30/12 001001003648 0.00 0.00 Sub s 0.00 0.00 $33,075.63 Financial charges and fees incurred but not funded during the statement period. PENDING FINANCIAL CHARGES AND FEES See future statements for processing information. Transaction Service Fees Net Amount Type Posted Description Posted SERVICE MASTERCARD CREDITS TRANS FEE.100000 TIMES 2-0.20 SERVICE MASTERCARD SALES DISCOUNT.003000 TIMES $6,827.53-20.51 SERVICE VISA SALES DISCOUNT.003000 TIMES $12,186.15-36.55 SERVICE MASTERCARD DEBIT SALES DISC.003000 TIMES $437.34-1.31 SERVICE VISA DEBIT SALES DISCOUNT.003000 TIMES $4,852.66-14.55 TOTAL SERVICE -73.12 FEE VISA NETWORK FEE CP 1B-01-2.00 FEE VISA NETWORK FEE CNP 2-06 -15.00 FEE MC NETWORK ACCESS AUTH FEE.018500 TIMES 38-0.73 FEE MC ACQUIRER AVS BILLING 1 TRANSACTIONS AT.005000-0.01 FEE Acquiring Bank, Issuing M/C INTERNET AUTH FEE.090000 TIMES 44-3.96 FEE MASTERCARD 950 AUTH FEE 1 TRANSACTIONS AT.090000-0.09 Bank, MasterCard, Visa, FEE MC CONNECTIVITY AUTH FEE.001500 TIMES 28-0.05 FEE Discover, and AMEX ACQUIRER PROCESSOR FEE CREDIT.019500 TIMES 77-1.52 FEE Fees ACQUIRER PROCESSOR FEE DB/PP.015500 TIMES 53-0.85 FEE VISA INTERNET AUTH FEE.090000 TIMES 107-9.63 FEE VISA 950 AUTH FEE.090000 TIMES 26-2.34 FEE VISA CONNECTIVITY AUTH FEE.002500 TIMES 131-0.36 FEE AMEX INTERNET AUTH FEE.055000 TIMES 27-1.52 FEE VISA ZERO AMT FEE.025000 TIMES 3-0.09 FEE CNP AVS FEE 1 TRANSACTIONS AT.007500-0.01 FEE VISA INTL SERVICE FEE 1 TRANS TOTALING $27.54-0.11 FEE VISA INTL SERVICE FEE 1 TRANS TOTALING $54.00-0.22 FEE VISA INTL SERVICE FEE 2 TRANS TOTALING $135.00-0.54 FEE VISA INTL SERVICE FEE 5 TRANS TOTALING $618.88-2.48 099382/000001/187698/0001/23882/0000/144034 000 05
Page 6 of 8 Financial charges and fees incurred but not funded during the statement period. PENDING FINANCIAL CHARGES AND FEES See future statements for processing information. Transaction Net Amount Type Posted Description Posted FEE VI TRANSACTION INTEGRITY FEE.100000 TIMES 7-0.70 FEE AVS 950 CALL AUTHORIZATION FEE.010000 TIMES 42-0.42 FEE INTERNET AVS AUTH FEE.010000 TIMES 3-0.03 FEE NON-RECEIPT OF PCI VALIDATION 1 TRANSACTIONS AT 19.950000-19.95 FEE US CROSS BORDER FEE 5 TRANS TOTALING $344.79-1.38 TOTAL FEES -63.99 INTERCHANGE MASTERCARD ASSESSMENT FEE.001100 TIMES $7,264.87-7.99 INTERCHANGE VISA ASSESSMENT FEE.001100 TIMES $17,038.81-18.73 INTERCHANGE These are the VI-CPS/RETAIL ALL OTHER (DB) -3.62 INTERCHANGE Interchange Fees VI-BUS ENH RETAIL -3.27 INTERCHANGE VI-SIGNATURE PREFERRED CRP STD -10.86 that are nonnegotiable for any VI-SIGNATURE PREFERRED CNP -5.76 INTERCHANGE VI-SIGNATURE PREFERRED RETAIL -29.24 INTERCHANGE INTERCHANGE Merchant Service VI-INTER PREM CAN ISS US ACQ -7.60 INTERCHANGE VI-BUSINESS CARD STD -3.39 INTERCHANGE Provider. VI-EIRF NON CPS ALL OTHER -111.21 INTERCHANGE VI-INTREG STANDARD (US) -1.01 INTERCHANGE VI-INTREG CHIP ISS (US) -3.12 INTERCHANGE VI-INTREG COMML STD (US ACQ) -6.36 INTERCHANGE VI-CPS/REWARDS 2-20.46 INTERCHANGE VI-CPS/REWARDS 1-37.77 INTERCHANGE VI-CPS/SMALL TICKET -0.58 INTERCHANGE VI-CPS CARD NOT PRESENT -13.20 INTERCHANGE VI-CPS/RETAIL ALL OTHER -7.50 INTERCHANGE VI-CPS/RETAIL ALL OTHER (PP) -0.97 INTERCHANGE VI-EIRF NON CPS ALL OTHER (PP) -2.88 INTERCHANGE VI-REG CONSUMER MQ (DB) -1.24 INTERCHANGE VI-US REGULATED COMM (DB) -2.26 INTERCHANGE VI-US REGULATED NON-CPS (DB) -1.31 INTERCHANGE VI-US CPS/SMALL TCKT REG (DB) -0.22 INTERCHANGE VI-US REGULATED (DB) -5.69 INTERCHANGE MC-DOMESTIC MERIT I (DB) -1.14 INTERCHANGE MC-DOMESTIC MERIT III (DB) -0.86 INTERCHANGE MC-HIGH VAL MERIT III BASE -25.29 INTERCHANGE MC-ENHANCED MERIT I -2.88 INTERCHANGE MC-ENHANCED MERIT III BASE -2.10 INTERCHANGE MC-PREM CON STD ACQUSISSCAN -3.91 INTERCHANGE MC-WORLD ELITE CORP DR I BUS -1.08 INTERCHANGE MC-WORLD ELITE MERIT III -4.31 INTERCHANGE MC-WORLD ELITE MERIT I -2.12 INTERCHANGE MC-CORP BUSINESS INTL FLT -2.28 INTERCHANGE MC-CORP DATA RATE I (US) CORP -6.38 INTERCHANGE REFUND: MC-CONSUMER CREDIT REFUND 3 1.20 INTERCHANGE MC-WORLDCARD MERIT III -8.73 INTERCHANGE MC-WORLDCARD MERIT I -82.35 INTERCHANGE MC-DOMESTIC MERIT I -2.12 INTERCHANGE MC-DOMESTIC MERIT III -0.66 INTERCHANGE MC-FOREIGN STANDARD PLUS -1.99 099382/000001/187698/0001/23882/0000/144035 000 06
Page 7 of 8 Financial charges and fees incurred but not funded during the statement period. PENDING FINANCIAL CHARGES AND FEES See future statements for processing information. Transaction Net Amount Type Posted Description Posted INTERCHANGE MC-REG CONSM WFRAUD ADJ MC(DB) -0.73 INTERCHANGE MC-REGULATED FRD ADJ COMM (DB) -0.26 INTERCHANGE MC-REG INCENT FRF ADJ POS (DB) -0.26 INTERCHANGE MC NTWRK ACCESS SETTLEMENT FEE.018500 TIMES 2-0.04 TOTAL INTERCHANGE -454.53 GRAND TOTAL -591.64 PENDING INTERCHANGE CHARGES Sales % Of Product/Description Sales These are the different Mastercard Nondebit Credit Cards used and the related interchange charges. Number of % of Interchange Cost Cost Per Rate Transaction Sub Interchange Charges MASTERCARD NONDEBIT FOREIGN STANDARD PLUS 92.34 1 1 2 2.15 1.99 DOMESTIC MERIT III 35.64 0 1 2 1.58 0.100 0.66 DOMESTIC MERIT I 106.68 1 1 2 1.89 0.100 2.12 WORLDCARD MERIT I 3,987.62 55 6 15 2.05 0.100 82.35 WORLDCARD MERIT III 470.10 7 4 10 1.77 0.100 8.72 CONSUMER CREDIT REFUND 3-61.56-1 -2-5 1.95-1.20 CORP DATA RATE I (US) COR 237.07 3 1 2 2.65 0.100 6.38 CORP BUSINESS INTL FLT 89.37 1 1 2 2.55 2.28 WORLD ELITE MERIT I 76.72 1 2 5 2.50 0.100 2.12 WORLD ELITE MERIT III 182.52 3 3 7 2.20 0.100 4.32 WORLD ELITE CORP DR I BUS 34.02 0 1 2 2.87 0.100 1.08 PREM CON STD ACQUSISSCAN 163.08 2 3 7 2.40 3.91 ENHANCED MERIT III BASE 103.68 1 3 7 1.73 0.100 2.09 ENHANCED MERIT I 126.37 2 3 7 2.04 0.100 2.88 HIGH VAL MERIT III BASE 1,122.33 16 6 15 2.20 0.100 25.29 MASTERCARD NONDEBIT TOTAL 6,765.98 34 144.99 MASTERCARD DEBIT REG INCENT FRF ADJ POS (D 88.44 1 1 2 0.05 0.220 0.26 REGULATED FRD ADJ COMM (D 87.21 1 1 2 0.05 0.220 0.26 REG CONSM WFRAUD ADJ MC(D 133.65 2 3 7 0.05 0.220 0.73 DOMESTIC MERIT III (DB) 68.04 1 1 2 1.05 0.150 0.86 DOMESTIC MERIT I (DB) 60.00 1 1 2 1.64 0.160 1.14 MASTERCARD DEBIT TOTAL 437.34 7 3.25 These are the different Mastercard Debit Check Card's that were used and the related interchange charges 099382/000001/187698/0001/23882/0000/144036 000 07
Page 8 of 8 These are the different Visa Nondebit Credit Cards used and the related interchange charges. PENDING INTERCHANGE CHARGES Product/Description Sales % Of Sales Number of % of Interchange Cost Cost Per Rate Transaction Sub Interchange Charges VISA NONDEBIT CPS/RETAIL ALL OTHER 476.39 3 3 2 1.51 0.100 7.49 CPS CARD NOT PRESENT 716.29 4 3 2 1.80 0.100 13.19 CPS/SMALL TICKET 30.00 0 2 2 1.65 0.040 0.58 CPS/REWARDS 1 2,137.32 13 25 20 1.65 0.100 37.77 CPS/REWARDS 2 1,019.28 6 6 5 1.95 0.100 20.48 INTREG COMML STD (US ACQ) 259.74 2 2 2 2.45 6.36 INTREG CHIP ISS (US) 189.00 1 3 2 1.65 3.12 INTREG STANDARD (US) 49.14 0 2 2 2.05 1.01 EIRF NON CPS ALL OTHER 4,774.42 28 14 11 2.30 0.100 111.21 BUSINESS CARD STD 108.11 1 1 1 2.95 0.200 3.39 INTER PREM CAN ISS US ACQ 337.54 2 2 2 2.25 7.59 SIGNATURE PREFERRED CNP 235.97 1 1 1 2.40 0.100 5.76 SIGNATURE PREFERRED RETAI 1,353.92 8 8 7 2.10 0.100 29.23 SIGNATURE PREFERRED CRP S 361.33 2 2 2 2.95 0.100 10.86 BUS ENH RETAIL 137.70 1 1 1 2.30 0.100 3.27 VISA NONDEBIT TOTAL 12,186.15 75 261.31 VISA DEBIT US REGULATED (DB) 1,265.27 7 23 19 0.05 0.220 5.69 US CPS/SMALL TCKT REG (DB 7.00 0 1 1 0.05 0.220 0.22 US REGULATED NON-CPS (DB) 423.36 2 5 4 0.05 0.220 1.31 US REGULATED COMM (DB) 1,877.00 11 6 5 0.05 0.220 2.26 REG CONSUMER MQ (DB) 730.37 4 4 3 0.05 0.220 1.25 EIRF NON CPS ALL OTHER (P 137.86 1 2 2 1.80 0.200 2.88 CPS/RETAIL ALL OTHER (PP) 71.28 0 1 1 1.15 0.150 0.97 CPS/RETAIL ALL OTHER (DB) 340.52 2 6 5 0.80 0.150 3.62 VISA DEBIT TOTAL 4,852.66 48 18.20 24,242.13 164 427.75 These are the different Visa Debit Check Card's that were used and the related interchange charges. TAX GROSS REPORTABLE SALES BY TIN dollar amount of aggregate reportable payment card transactions funded and third party network transactions, for each participating payee, without regard to any adjustments for credits, cash equivalents, discount amount, fees, refunded amounts, or any other amounts per respective tax identification number. Month Description August GROSS REPORTABLE SALES- 2012 YTD Gross Reportable Sales See www.businesstrack.com to review details of your statement. 099382/000001/187698/0001/23882/0000/144037 000 08