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: <br /> <br />MERCURY PAYMENT SYSTEMS <br />Merchant Information Form <br />~ba name: Springvale Golf Course and Ballroom <br />American I_xpress Verification: <br />Please call and verily your men:hant number with Amex at 1-800-528-5200 <br />Amex Merchant (or SE) Number: (10 Digits) <br />3346649205 <br />Mist Information: <br />Federal Tax ID: 346002048 (9 Diaits) <br />Chargeback correspondence: <br />Please confirm that the following FAX and/or mailing address is valid for alt Sales Draft Retrieval correspondence: <br />440-777-4653 <br />Citv of North Olmsted <br />5200 Dover Center Road <br />North Olmsted. OH 44070 <br />If you wish to include any additional contacts for your account, Please complete the following: <br />Co-Owner: This person has full rights to your account. This person may change banking information, change contacts on account(s), <br />change DBA information. This person may view transactions on the website and will be an admin on the website, which grants <br />employee access to the account(s). <br />Name <br />Phone: <br />Email: <br />Primary Contact: This person can view transactions on the website, call in transaction problems, change contacts on account(s) and <br />change DBA information on all of your accounts. This may be an Accountant or General Manager. This person may also sign for gift <br />card and terminal orders. <br />Phone: <br />Manager: This person may call in transaction problems and view individual store transactions on the website. <br />Nam <br />Phone: <br />Email: <br />Signature: <br />Carrie Copier <br />8788430056479 <br />Cartwright <br />Mercury Payment Systems is a registered ISO and MSP of HSBC Bank, USA, National Association, Buffalo. NY <br />10 Burnett Court, Suite 300 • Durango, Colorado, 81301. 800-846-4472 • www.mercurypay.com <br />