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~.IHPS MERCURY PAYMENT SYSTEMS Merchant Application FOR MERCURY PAYMENT SYSTEMS CREDIT CARD PROCESSING SERVICES - . . Merchant's DBA/Outlet Name: Springvale Golf Course and Ballroom Merchant's Legal Name: City of North Olmsted Address: 5871 Canterbur Road Y ~ _..___ - - - - Address: 5200 Dover Center Road Cit ,State, Zi :North Olmsted, OH, 44070 __~ ~" _.._. _ __ Cit~State Z~ North Olmsted,OH, 44070 one, Fax:440-777-0678, 440-777-4653 Phone, Fax: 440-777-0000, 440-716-4235 Contact Name at this Address:Carrie Co fer Contact Name at this Address: Carrie Copfer -mail: co erc@north-olmsted.com Email: coperc@north-olmsted.com r-------.------ __ .~~...____-_.~._-G _•_- ___-~___ od~~R r+ccourn io oe urea ror areal[ Cara t'rocessing Services: Business Type: r Sole Proprietorships Partnership r Professional r Corporation r LLC x Tax Exempt Organization 501 C t- Other Does merchant accept transaction before the customer receives product or service? r' Yes x No of sales in this category: --~..._______.__._.._.._w.____..-.__. __. __......_. .... Does merchant offer warranties, dues, subscriptions, memberships or Type of Goods or Services Sold: Golf Course/Banquet Facilities other extended services? r" Yes x No SIC Code: 7992 Duration of extended service or benefit (weeks): -. ____.a_.._ __._-.._..._~._.__-.....__.._-...... ._ . Years in business under current ownership: 15 Annual Visa/MC/ Discover sales ($): $350,000 Federal Tax ID #: 346002048 `"""" Average Ticket ($): 36 _.._ Do you currently accept Visa/MasterCard/Discover? Total Visa/MC/ Discover Sales (multiple locations only) r Yes x No ($) $350 000 American Express Merchant SE#: 3346649205 EBT Merchant FNS # _ Does the Merchant use a Fulfillment House? r' Yes x No If yes, was Fulfillment House inspected? r Yes r- No The above sales volumes and average ticket $ representations are integral and a condition to the fees, charges and discounts set forth in the below fee schedule. If your actual sales volumes or average ticket $ are different than the sales volumes or average ticket $ represented above, you understand and agree that your fees and/or charges may be changed. Market Type: x Retail r Supermarket r- Restaurant E-Commerce r MO/TO r Lodging r Emerging Mkt. r- P-Card r Public Sector r Auto Rental r Cash Adv. n Other Sales Profile (must equal 100%): Card Swiped: 95 Manually Keyed with imprinter: 5 Mail OrderlTelephone/Internet: _ HSBC Bank USA, National Association ~ ~-__.____ ...~ Merchant Support Group P.O. Box 3263 Buffalo, New York 14240 716.841.6360 Important Member Bank Responsibilities 1. A Visa Member is the only entity approved to extend acceptance of Visa products directly to a merchant. 2. A Visa Member must be a principal (signer) to the Merchant Agreement. 3. The Visa Member is responsible for educating Merchants on pertinent Visa Operating Regulations with which Merchants must comply. 4. The Visa Member is responsible for and must provide settlement funds to the Merchant. 5. The Visa Member is responsible for all funds held in reserve that are derived from settlement. regarding Card 8788430056479 Cartwright Important Merchant ResponsibUities 1. Ensure compliance with cardholder data security and s(orage requirements. 2. Maintain fraud and chargebacks below thresholds. 3. Review and understand the terms of the Merchant Agreement 4. Comply with Visa Operating Regulations. The responsibilities listed above do not supersede terms of the Merchant Agreement and are provided to ensure the Merchant understands these specific responsibilities. contact: ercury ayment Systems, Inc. 10 Burnett Court, Suite 300, Durango Co 81301, or call 1-800-846-4472 I, in writing to Customer Service within 60 days of the date of the statement and/or notice. 10 BumefF Court, Suite 300 Dtrrartgo, Colorado, 81301 (800)846-4472 www.MercuryPay.com Mercury Payment Systems, Inc. is a registered ISO and MSP of HSBC Bank, USA, National Association, Buffalo, NY Rev.04/OS MPS