and Agreement Form ( MPA )

Merchant Processing Application and Agreement Form ( MPA ) Revised December 2011 1

General Binding Contract Information Item Merchant Processing Application and Agreement ( MPA ) Action This is a legal binding contract. Please use black ink and must not contain white outs or cross outs. MPA must be completed and contain legible information, disclose all rates and fees, and be signed by legal owner or officer of the company. Original must be provided to Corporate within 15 days of submission for every merchant account (approved or declined). Make sure to use the most recent MPA version: DataGene1410(ia) Additional Credit Information Site Survey The additional credit information may not be necessary for all types of merchants. The site survey allows all appropriate entities to determine whether the merchant has the proper facilities, equipment, inventory and license or permit, necessary for the merchant to conduct business. The completion of Section 2 of the MPA by the IBM satisfies this requirement. Voided d Check or Letter on Bank Letterhead Merchant Services Program Guide Confirmation (Page 39) A voided check is required to ensure the integrity of the merchant s banking information where funds are to be remitted and fees are debited. The voided check should properly reflect merchant DBA or Legal name, current address, DDA & ABA. Starter checks are not acceptable. If a voided check is unavailable, a letter on bank letterhead signed by an officer of the bank is acceptable (must have DBA name, DDA, ABA). The DDA must be a business checking account and must accept both credits and debits. The Program Guide contains the operating procedures and general terms, which together with the MPA constitutes the complete Merchant Processing Agreement. The last page of the Program Guide Page 39 must be signed by the merchant as confirmation, they have received a copy or advised where to view a copy online. 2

Sales Office Information: Top Portion of the MPA Page 1 Sales Office Data Genesis Print Sales Rep Name The name of the Independent d Business Manager ( IBM ) completing the MPA. Sales ID# Merchant Number Sales Rep Signature Phone # The IBM ID # assigned by Data Genesis Corporation upon activation. This number will be used on all forms requiring Sales ID#. Merchant Identification Number ( MID ). This number is completed by the Corporate Office when merchant account is approved. The signature of the IBM who completed the MPA with the merchant (same person assigned to the above Sales ID#). The contact number of the IBM completing the MPA. 3

Section 1 Business Information This section of the MPA encompasses the Doing Business As (DBA) and the Corporate (Legal Name) information. Client s Business Name Business Address, City, State, Zip: Location Phone # / Location Fax #: Business e-mail & Website Address: Customer Service Phone #: Name of the merchant s Doing Business As (DBA) business location. Address of the merchant s (DBA) business location. Merchant s location phone number / location fax number. e-mail and/or URL of where business is transacted. Please be sure to complete e-mail address for all merchants. Website address REQUIRED for Internet merchants. The merchant s customer service number will be placed on the cardholder s statement. If merchant does not have a dedicated Customer Service # use their location phone #. Client s Corporation/Legal Name or HQ: If different from DBA, enter the Merchant s Corporate/Legal Name or Headquarter info. Billing Address, City, State, Zip: Contact Name: If different from DBA, enter the address of the merchant s Corporate/Legal/HQ location. Name of the contact at the merchant s Corporate/Legal/HQ location. Contact Phone & Fax # & E-mail Address: Merchant contact s direct line, fax and email address. Send Retrieval Request to: Select Business or Corp/Legal location where retrieval requests will be sent. Send Merchant Monthly Statement to: Select Business or Corp/Legal location where merchant monthly statement will be sent. 4

Section 1 Business Information cont d How the business is registered Name Federal Tax ID# I certify that I am a foreign entity/ nonresident alien SIC/MCC Detailed Explanation of Select one of the choices describes the type of business entity (i.e. Individual, Corporation, etc.) IRS Filing Name name that merchant files taxes under (complete full name).»sole Proprietor owners name.»company s Name»If unsure, ask for former tax filings Federal Tax ID or Social Security Number for the business; must be correct number. If IRS filing name is owners name, tax ID is owners Social Security #. Certain LLCs follow Sole Proprietor path others follow the company path. Company / Corporation use EIN Foreign Entity Indicator. We are unable to process business outside of the US at this time.»check this if merchant is not located in United States.»If checked, need to provide W-8 form. DO NOT FILL IN. This is assigned by Corporate. Type of Merchandise, Products or Services Sold be as specific as possible. Include copy of the business card if possible. This information helps Corporate assign the correct SIC/MCC. 5

Section 2 Additional Credit / Site Survey Information The Additional Credit/Site Survey Information section encompasses the Site Survey, MO/TO, B2B & Internet Information. Are you using a vendor: Check [NO] DG strongly encourages IBM s to complete the site visit. Outside vendor site visits are discouraged. However, if necessary, must be done by a certified vendor. Call Corporate for information. Question 1-13: Select the appropriate information. Answer all 13. Advertising Method: Question 15 and 16: Select the appropriate information. Marketing Materials are required for Mail Order, B to B, Internet over $1 Million in annual volume. Attach Web Page for Internet Merchant. Name of previous processor and reason for leaving. Attach copy of previous processor statement. Mail / Telephone Order / Business to Business Information Question 3 & 4 should be completed for all merchant types. Complete Questions 1-6 if merchant is Mail / Telephone Order / Business to Business. Refer to Credit Policy in the Program Standards for information on MO/TO and B2B requirements. 6

Section 3 Company History The Company History section encompasses the date the business opened, bankruptcies and trade references. DBA Name / Merchant # Date Business Started: Prior Bankruptcies?: Trade Reference 1: Trade Reference 2: Note: Fill in the DBA Name only. Corporate will fill in MID# when approved. The date the business opened. (MM/YYYY) Select Yes or No and Select Business and/or Personal. The vendor s information used by the merchant. The vendor s information used by the merchant. All High Risk*,(Internet and MOTO merchants require 2 Trade References. Trade References are also required for Regular Risk*) merchants who process over $2 Million in Bankcard transactions a year. Refer to Credit Policy in the Program Standards for more information. 7

Section 4 Owners / Partners / Officers The Owners / Partners / Officers section encompasses the individuals whose financial reports are researched by Risk and/or Underwriting Departments. Name / Title / Home Address / Telephone # Ownership Social Security # FULL SSN IS REQUIRED D.O.B./ DL# / State Full name, full title, full home address. No threshold per ownership 1% to 100% NOTE: The ownership of percentage is required field for Amex OnePoint. Per Amex Operating Regs, Amex requires a percentage be provided for a private company (not required for a public company). There is no threshold requirement, the only requirement is to supply the information. SSN s are required. Having said that if a signer does not want to provide SSN, then either of the following is required: 1. Copy of a valid passport or; 2. Copy of a valid driver s license and birth certificate. For your information, SSN s are required in all applications, except for the following: 1. Publicly-traded companies; 2. Nationally known charities such as the Red Cross, United Way, et al; 3. MPA s submitted from bank partners, in which case, the signer has already been OFAC screened. 4. Government entities. If the merchant does not fit any of the above categories, SSN s are required. Date of Birth, full driver s license number and state issued. Don t forget to get a copy of the driver s license used to verify signature. 8

Section 5 Settlement Information The Settlement Information section encompasses where the merchant s funds should be deposited and fees should be withdrawn as well as how to report daily disbursement details. Deposit Bank Transit / ABA # Bank Contact Deposit Account # Full name of merchant s bank Full transit routing number (ABA number). Ensure the number matches the number on the voided check or the number on the bank s letterhead. If unknown, enter branch manager or customer service. Full deposit account number. Ensure the account number matches the number on the voided check or the number on the bank s letterhead. Select Individual unless the merchant requests a different detail. The ACH Detail Flag representing how to report daily disbursement details, including records for deposits, discounts and adjustments, on the merchant s bank statement. ACH Detail Flag Individual a separate outgoing ACH for EACH batch deposit, a separate outgoing ACH for EACH batch discount, and a separate outgoing ACH for EACH adjustment record. Combined reports net deposit into one line on merchant s bank statement. t t Separate one outgoing ACH (by credit card brand) for all deposits, a separate outgoing ACH for all discounts, and a separate outgoing ACH (by credit card brand) for all adjustments. 9

Section 6 Equipment / Third Party Information The Equipment / Third Party Information section encompasses the POS Device(s) the merchant will use to process transactions as well as the leasing agreement with First Data Global Leasing. Network Platform (Front End) Do not fill in Corporate will select network based on terminal and/or payment software. Third Party Information Please select Yes or No. If Yes, provide as much information as possible. This information is important for PCI compliance. Provide information regarding the merchant s equipment. Terminal / Equipment Information Lease Company: Internet Gateway list the name of existing gateway (if applicable). PC/Internet Software list the name of existing PC/Internet Software (if applicable) and ID# (if possible). Wireless Network list the name of the existing wireless network (if applicable). Terminal list Type & Model. Conversions - list the serial number on Terminal Setup Form. Printer Model list check reader/scanner (if applicable). Pin Pad must be FDMS (or FDC), #300 3DES key encrypted. Complete this section if the above equipment will be leased through First Data Global Leasing ( FDGL ). Important to note: this section is the legally binding contract with the merchant and FDGL. For additional i information i regarding the lease see the Merchant Services Program Guide (see Part II, page 25). 10

Section 7 Grid Information The Grid Information section encompasses all grid IDs associated with the merchant account. DO NOT FILL IN ALWAYS completed by Corporate. Authorization Grid ID# User Defined GidID# Grid Do not fill in Corporate will complete. 3-digit auth grid ID associated with the Auth and Capture Pricing in Section 9 of the MPA. Do not fill in Corporate will complete. 3-digit user defined grid ID associated with the Monthly fees in Section 9 of the MPA. 11

Section 8 Transaction Information The Transaction Information section encompasses Financial Data and Where the Transaction is Processed. Gross Yearly Sales Volume Average Yearly MC/Visa Volume Average Yearly Discover Network Volume Average Yearly American Express OnePoint Volume Seasonal? High Volume Month s Open Avg. MC / Visa / Discover Network Ticket (Estimate If Never Processed In Past) Includes cash, credit, debit and checks estimate high. Includes Visa and MasterCard estimate high. Discover Full Acquiring estimate high. American Express OnePoint estimate high. Select Yes or No. Yes indicates the merchant is seasonal and closes for a portion of the year. No indicates the merchant is open all year with months of high peak sales. High Volume Months Open: please note the months of high peak sales. Includes Visa, MasterCard and Discover Full Acquiring estimate high. Avg. American Express OnePoint Ticket (Estimate If Never Processed In Past) American Express OnePoint estimate high. Use AMEX chart to estimate. Highest Ticket Amount Highest dollar amount the merchant would process estimate towards high. Where is sale transaction Ensure total equals 100%. Merchant Initials Have the merchant initial the fee/costs assessed for this area. 12

Section 9 Service Fee Schedule: Authorization & Capture Transaction Fees This section encompass all authorization communication fees via an Authorization Income Grid. 0.25 0.25 0.25 0.25 0.00 1.50 0.10 2.00 1.00 Standard pricing based on Tier 1 Merchants DG Conforming Pricing Program. MasterCard and Visa Authorization & Capture Fee (per item) Discover Network Authorization & Capture Fee (per item) American Express OnePoint/ Full Service (EDC) OR American Express ESA / Pass Through American Express Authorization JCB Authorization Amex ESA / Pass Through h SE# JCB SE# Price disclosed to merchant for VS /MC authorization and batch settlement fee (associated with authorization income grid). Price disclosed to merchant for DISC Full Acquiring authorization ation and batch settlement fee (associated with authorization income grid). Check which type of American Express merchant currently has, or wants to have. Price disclosed to merchant for Amex One Point / non- Amex One Point (ESA) authorization. Amex One Point authorization fee must be the same as the Visa/MasterCard/ Discover. Price disclosed to merchant for JCB authorization. Amex service establishment number. If merchant does not have one, write NEW in field. DO NOT USE - JCB service establishment number. TransArmor Auth Fee, Voice Authorization, Communication pricing associated with authorization income grid. Electronic AVS Fee, Voice AVS Fee, ARU Fee s defined in detail on the next page. 13

Section 9 Service Fee Schedule Authorization & Capture Transaction Fees Communication pricing associated with authorization income grid. Standard pricing based on Tier 1 Merchants DG Conforming Pricing Program. 0.00 1.50 0.10 2.00 1.00 TransArmor Auth Fee Reserved for future use. Do not use at this time. Voice Authorization Electronic AVS Fee Voice AVS Fee Automated Response Unit (ARU) Fee Fee charged for calling 800-228-1122 for a voice approval from an authorization representative. Fee charged for Address Verification Service (AVS) through the merchant s point-of-sale (POS) device. Fee charged for AVS via 800-228-1111 / 800-228-1122, completed by an authorization representative. Fee charged for 800-228-1111 to process and batch transactions over the automated response unit via touch-tone telephone 14

Section 9 Service Fee Schedule Miscellaneous Fees This section encompasses various fees that will be explained on the next few pages. 0.00 25.00 15.00 0.00 0.25 495.00 0.00 0.00 0.00 25.00 995 9.95 0.00 0.00 0.00 0.00 Dues and Assessments *Standard Pricing N/A Do not check box. Checking will pass additional Dues and Assessments to the merchant. Chargeback Fee $25.00 Chargeback fee to the merchant. Retrieval Fee (12B Letter) $15.00 Processing fee charged to merchant for receipt of each retrieval request. Return Trans. Fee $0.25 Return Transaction fee to the merchant. This amount is equal to auth & cap fee. *Standard pricing based on Tier 1 Merchants DG Conforming Pricing Program. 15

Section 9 Service Fee Schedule Miscellaneous Fees cont d This section encompasses various fees that will be explained on the next few pages. Sales Transaction Fee (per item) *Standard pricing $0.00 Fee assessed on all settled transactions. If you place a price here AND in the Auth & Capture Fee you will be billing the merchant twice for transaction fees. Batch Fee (per item) $0.00 Early Termination Fee (one-time fee) EBT-Food Stamps / EBT-Cash Benefits $495.00 If applicable If you place a price here AND in the auth & capture fee the merchant will be billed twice for settlement. Early termination fee to the merchant if they cancel prior to the end of the processing contract. Sales transaction fee to merchant for accepting EBT transactions. The merchant has to have an SE# provided by the gov t to be able to accept EBT transactions. Enter SE# next to (per item) on line provided. Other If applicable This is a yearly fee specified. All monthly fees are captured in separate section. Annual Fee Optional Annual fee. DG typically does not assess an Annual fee. MC Other Item Rate $0.00 MasterCard transaction fee assessed on settled item (in addition to auth & cap fee). Visa Other Item Rate $0.00 Visa transaction fee assessed on settled item (in addition to auth & cap fee). Discover Network Other Item Rate $0.00 Discover (non full acquiring / full acquiring) transaction fee assessed on settled item if used it is in addition to auth & cap fee. Amex Other Item Rate $0.00 Amex (ESA/one point) transaction fee assessed on settled item. Amex OnePoint Other Volume % $0.00 Percentage (basis points) assessed on net volume of Amex OnePoint transactions. Cannot use unless used for other card brands as well. JCB Other Item Rate $0.00 JCB transaction fee assessed on settled item. Minimum Monthly Fee $25.00 Minimum monthly fee only ACH d if minimum is not met. Monthly Statement Fee $9.95 Monthly statement fee assessed to merchant. *Standard pricing based on Tier 1 Merchants DG Conforming Pricing Program. 16

Section 9 Service Fee Schedule Miscellaneous Fees cont d Select Yes Pass the fee to the merchant. Payment Network Pass Thru Fees Pass Visa ACQ ISA Fee Pass Visa Acquirer Processing Fee Pass Visa Misuse of Auth Fee Pass Visa Zero Floor Limit Fee Pass Visa International Acquirer Fee Pass MC Acquirer Support Fee Pass MC Cross Border Fee Pass MC Network Access & Brand Usage (NABU) Fee Pass MC Processing Integrity Fee Pass Discover International Processing Fee Pass Discover International Service Fee Pass Discover Data Usage Charge Fee Fee Definition Visa ISA fee of 0.40% is assessed against the volume of the transaction when the transaction involves a US merchant and a foreign issuer. Visa Acquirer Processing fee is currently $0.0195 per Visa branded authorizations acquired in the US regardless of where the issuer/cardholder is located. Visa Misuse of Authorization System fee is assessment of $0.045 fee for each authorization that does not have a subsequent clearing record or authorization record. Visa Zero Floor Limit fee is an assessment of $0.10 fee for each transaction that does not have an approved authorization. Visa International Acquirer fee is 0.45% of the sale transaction on all international transactions with the exception of high risk merchants (assessed 0.90%). MasterCard Acquirer Support fee of 0.55% is assessed to transactions qualifying for specific International interchange programs. Also assessed to Cirrus & Maestro transactions. MasterCard Cross Border fee is assessed with transactions that involve a US merchant & a foreign issuer. The fee is 0.40% of the transaction amount. MC Network Access Brand Usage fee of $0.0185 applies to all transactions. MC Processing Integrity fee ($0.055) will apply to authorizations that are not cleared or reversed within MC time frames. MC will assess the fee on authorizations not matched to a subsequent clearing record within 120 days of the original authorization. Reversals must occur within 24 hours (CP) & 72 hours (CNP). Discover International Processing fee (0.40%) charged for card sales (including cash over) & cash advances conducted at merchant in a country other than the country of domicile of the issuer of the card used in the card sale or cash advance, provided that such a fee is not applicable to card sales or cash advances with JCB or China Union pay cards. Discover International Service fee (0.55%) for card sales (excluding cash over) conducted at a merchant location in the US where the domicile of the issuer of the card used is a country other than the US provided the fee is not applicable to card sales with JCB and Chine Union Pay. Discover Data Usage Charge fee ($0.0185) charged for the processing of Sales Data. 17

Section 9 Service Fee Schedule Miscellaneous Fees cont d Monthly Fees Section: Reoccurring Monthly fees identified in a User Defined Grid. *Standard Pricing Wireless Fee $25.00 Applicable to wireless terminals (per terminal). Portfolio Manager $0.00 00 - $4.95 emerchantview Access Fee $5.95 Minimum assessed fee. This product may be offered for free. IBM s discretion on charge. Customer Service Fee $0.00 DG typically does not assess a Customer Service fee. Debit Access Fee $5.00 Supplies $0.00 Other: Regulatory Fee See TIN/TFN fees section for additional fees. $7.95 Other: Wireless Set-Up Fee $99.00 Other: Global Gateway Set-Up Fee Fee assessed to merchant if using debit to allow access to debit network. Merchant orders supplies directly from Supply Desk 866-210-8463 Fee charged to merchant to cover costs associated with managing and supporting the various IRS regulations related to verifying and reporting Tax Identification Numbers (TIN) and Tax Filing Name (TFN) and reporting settlement payments of credit card transactions to the IRS. This fee is directly related to Section 6050W of the Internal Revenue Code. New Leases: Set-Up Fee is Waived Conversions: Set-Up Fee Assessed (includes 1 st month $25.00 wireless fee) If multiple terminals call Sponsor or RM. $39.95 Minimum set up fee for the global gateway program Other: Global Gateway $7.50 Access fee per store ID number. *Standard pricing based on Tier 1 Merchants DG Conforming Pricing Program. 18

Section 9 Service Fee Schedule Miscellaneous Fees cont d This section encompasses Network Acceptance and Discount Method. Accept all MasterCard, Visa and Discover Network Transactions It will be presumed that the merchant will accept and process MasterCard, Visa, Discover Network credit and non-pin debit; unless specified here. Discount Collected A merchant s discount can be collected daily or monthly. You should check Discount Collected Monthly. We would only use daily if advised to do so by the Risk Management Department. This section encompasses all IRS Reporting fees. Reg. Product Fee TIN/TFN Invalid Fee *Conforming Pricing N/A $10.95 Website Usage $0.00 IVR Usage $0.0000 Reserved for future use. Our company policy is to disclose this fee under Monthly Fees Other: Regulatory Fee (see previous page for more information). TIN/TFN Invalid fee is assessed on accounts with missing or otherwise invalid merchant IRS identifier, which will continue to be a combination of the taxpayer identification number (TIN) and the tax filing name (TFN). Usage of www.myclientline.net to make updates to a merchant s TIN/TFN. Usage of 1-866-753-9971 to make updates to a merchant s TIN/TFN. 19

Section 9 Service Fee Schedule Pricing Methods Complete the appropriate section(s) based on the pricing option applicable to the merchant. The following pages provide information for the 3 pricing i options:»tiered»err»pass Through Interchange Includes Dues and Assessments 20

Section 9 Service Fee Schedule Pricing Methods cont d TIERED PRICING DG does not recommend or support Tiered Pricing. Effective May 1, 2010 Visa increased the Visa Signature Debit fee by $0.02. To capture this increase use this Tiered Pricing Section by inserting $0.02 02 on MPG TXN Fee on Visa Qual Debit only. 0.02 21

Section 9 Service Fee Schedule Pricing Methods cont d ERR Enhanced Recover Reduced Pricing Discount is the flat rate assessed on all transactions regardless of qualifications. Non-Qual Fees is the surcharge fee that would be assessed on all non-qualifying transactions. CARD PRESENT *STANDARD ERR PRICING STRUCTURE DG #100 DISCOUNT FEES Qualified Credit 1.69% Signature Debit 1.69% Non-Qual Fees 1.00% 1.69 1.69 1.00 1.00 1.69 1.00 1.69 1.00 1.69 1.00 1.69 1.00 CARD PRESENT *STANDARD ERR PRICING STRUCTURE DG #200 DISCOUNT Qualified Credit 1.69% Signature Debit 1.69% Non-Qual Fees FEES 0.75% CARD PRESENT *STANDARD ERR PRICING STRUCTURE DG #300 DISCOUNT RATE Qualified Credit 1.69% Signature Debit 1.39% Non-Qual Fees FEES 1.00% CARD NOT PRESENT *STANDARD ERR PRICING STRUCTURE DG #400 INTERNET FEES RATE Qualified Credit 2.19% 1.00% Non-Qual Fees 1.69 0.75 1.69 0.75 1.69 1.69 0.75 1.69 0.75 1.69 0.75 0.75 1.69 1.00 1.69 1.00 1.69 1.00 139 1.39 100 1.00 139 1.39 100 1.00 139 1.39 100 1.00 219 2.19 100 1.00 219 2.19 100 1.00 219 2.19 100 1.00 2.19 1.00 2.19 1.00 2.19 1.00 *Standard pricing based on Tier 1 Merchants DG Conforming Pricing Program. 22

Section 9 Service Fee Schedule Pricing Methods cont d Pass Through Interchange and Pass Through Debit Network Fees Ensure this box is checked to properly disclose Interchange and Dues & Assessments fees are passed through. 0.00 0.00 0.50 0.50 0.50 050 0.50 050 0.50 050 0.50 We do not charge Other Item Rate or Other Volume % - These fees would Basis points assessed on gross sales volume: be in addition to auth & cap. MasterCard Qual Credit/MC Qual Debit 0.50% Visa Qual Credit/Visa Qual Debit 0.50% 050% Discover Network Qual Credit/Discover Network Qual Debit) 0.50% Ensure this box is checked to properly disclose PIN Debit Network fees are passed through. 0.25 0.00 Other Item Rate: Transaction fee assessed on settled items. Standard pricing = $0.25 Other Volume Percent: We typically y do not charge Other Volume Percent. 23

Section 9 Service Fee Schedule Pricing Methods cont d Complete the appropriate section(s) based on the pricing option applicable to the merchant. The following pages provide information for: American Express OnePoint TeleCheck Fleet 24

Section 9 Service Fee Schedule Amex OnePoint Use only this Pricing set by American Express. We have no control over Amex pricing. Check the appropriate box for the merchant s business category and write in the corresponding Discount Rate as indicated on the chart below. For assistance selecting the merchant s business category, call Corporate 855.295.8500. 25

Section 9 Service Fee Schedule Fleet and TeleCheck If merchant has existing account with Telecheck we cannot change rate, fill in existing SE Number If new account check ECA TeleCheck: This section of the MPA is used as the legal binding contract with a merchant 1.69 who accepts TeleCheck. Standard Pricing is 1.69 Inquiry Fee and $0.25 per 025 0.25 TXN fee. All other fees are set by TeleCheck and cannot be changed. Fleet: Call Corporate for rates. 26

Section 10 Signature(s) Obtain a signature for all principals listed in Section 4 of MPA Merchant initials on bottom of Pages 3 & 4 Personal Guarantee always recommended all merchants. Personal Guarantee is required for Tier II merchants and First Data Global Leasing 27