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C] Guarantee: im Non-Guarantee
[s Transaction and Batch | % Discount Rate [s Return Is Reversal ]
% will be applied:
oO ‘Bil Pay (existing customers) E-Commerce
$ . Transaction % Discount Rate § Batch ]
$ Return $ Reversal
$ Monthly Mintmum, . $ Monthly Paya Services Virtual Terminal Fee
$. . Monthly Service Fee * $ *|Setup Fee
ot avallable for:Paper Check or-Che
§ ---+ "Transaction Fee is Return Fee Cutoff Time for swiftsettle Is 10 AM Central:
- Merchant will submit the following typa(s} of SwiftSettle transactions: Does merchant desire the abllity to choose which Wansadionst to process SwiftSettle? °
. ier Debits “J. “Consumer Credits im} YES, q need thls capability [Zi] No, all transactions will be SwiftSettle
OF
Merchant acknowledges that the total amount into the payment entry
system already Includes the convenience fee added to the total sale.*
Merchant acknowledges processor will add consumer convenlence fee
to the total amount entered into the payment entry system after the
transaction has been recelved.*
How Is the customer's conserit to electronically debit their account captured? Check the box and complete fields forall applicable programs:
1 st. Recorded Verbal Authorization (*Checks-by-Phone” — TEL)
1 Processor provided script i Merchant created script (must submit copy with application}
~-: [1] Please provide Instructions to access customer recordings. If only able to access internally, please provide contact name in the Otherfleld,
Via website URL:
“Login / Username: .| Password:
‘Vie a telephone#: _ Password:
Other / required info/lD: .
EK) 2. Web Authorization ("Checks-by-Web” ~ WEB}
[k] Customer provides electronic signature (1 customer logs in using a usemame / password
“Merchant's website meets minimum enctyptlon or security session requirements? (Minimum 128- bit RC4 encryption) . [R] Yes [E] No
Are any transactions to be Initlated fram a website other than the main company website supplied on page 1? 1 ves No
If yes, list other URL(s}:
(Important: Merchant Is required to post any point of sale consumer notice provided by processor)
1. Transactions will be submitted vi
Merchant will use a certified web gateway. (see certified web gateway lis Gateway: MuniciPAY
2. On NSF returns, processor automatically resubmits transaction:
TC] Yes (standard) JR] No (optional - not available for Guarantee services)
3. Please provide merchant’s technical contact’s Information so we may contact them te provide gateway or file specs, coordinate a test file, etc. Required if selecting
transaction submission methods of Internet Gateway or File Transmission.
Name; Emall Address: Phone:
Application for Merchant Account — Check and ACH Processing REVO5152023 Page 2 of 11,
PLEASE NOTE: The complete Merchant Agreement Includes this Application and the Terms and Conditions on eight (8} additional pages.