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Aft GATEWAY SERVICES APPLICATION A SHIFr4COtdPANV Submit this form to sign up for Shift4 gateway services. Must be submitted with appropriate payment processor VAR Sheet. Office Name: FT005 FPOS Group 1 Rep Name: Matt Logan Office Code: FT005 ID New Location LPAddifi.n.1 Location ❑Processor Change ❑Gateway Change i Existing Shift4 Serial # (if applicable): Merchant cut -over: — End of Business Day: — (at least 1 hour after close of business) Date: Auto Batch Settlement Time: (business local time) Time: ❑ 10:00 am FT ❑2:30 pm ET 0930 pin ET )If none selected, settlement will default to 4:00 am local tithe) MERCHANT INFORMATION Merchant DBA Name: Springvale Golf Course and Ballroom Owner Name: City of North Olmsted, OH ..... ................... Merchant Legal Name: City Of North Olmsted, OH Federal Tax ID: 34-6002048 Business Address: 5871 Canterbury Road and 5200 Dover Center Road Last 4 Digits of Owner's SSN: Gty: North Olmsted State: OH ZIP: 44070 Owner Phone 440- 716 4603 Owner Email: mildb@north-Olmsted cam (Brlttani Mild) Alternate Contact Name: 440-777-0161 Alternate Contact Title: Event COordinatero Alternate Contact Phone: 440-777-0678 Alternate Contact Email: SHIFT4 GATEWAY Setup Fee. $ Monthly Gateway Fee. $ 10D _ Per Transaction Fee: 5 07 Professional Service Fee: $ SECTIONS 3 6 AND 23.18 PERMIT SHIFT4 TO CHANGE FEES AND CHARGES UPON 30 DAYS'WRITTEN NOTICE, WHICH WILL USUALLV APPEAR IN YOUR MONTHLY STATEMENT MESSAGE. PLEASE REVIEW YOUR STATEMENT EACH MONTH TO ENSURE ALL CHARGES ARE CORRECT AND TO LEARN OF ANY NEW OR AMENDED FEES OR CHARGES. APPROVED EMV EQUIPMENT ` ISV/Dealer/Merchant is responsible for purchasing, provisioning and installing EMV readers with correct P2PE encryption keys and debit keys. Number of Devices: s- _ To view all certified EMV devices, please visit https.//www.sliift4,coin/dem/integration/third-party-devices.cfm. AMERICAN EXPRESS SETUP REQUIREMENTS e ESA / OptBlue - Must include AMEX SE# on the Shift4 VAR Sheet specific to the Customer's Processor (CAPn form not required) e Reverse PIP / Split Dial - In this situation, we need the AMEX CAPn form completed (available on the Shift4 website) PAYMENT INFORMATION Shift4 Payments to bill merchant (must complete ACH Authorization Release on page 2) ❑Dealer to bill merchant SPECIAL INSTRUCTIONS (SUBJECT TO APPROVAL} By their execution below the urde,s gri partes agree to abide by the SHIFT4 PAYMENTS GAT EWA" SERVICES AGREEMENT (the "GATEWAY SERVICES AGREEMENT") The GATEWAY SERVICES AGREEMENT consists of this Gateway Services Application and the GATEWAY SERVICES AGREEMENT TERMS AND CONDITIONS I"TERMS AND CONDITIONS") (available at wwwshift4_com/gateweyterms). MERCHANT ac Knowiedges it has received and read the TERMS AND CCNDITIONS at the time of signing. MERCHANT warrants that the information provided on the Gateway Services Application s complete and accurate. MERCHANT authonzes Shift4 Payments, LLC, ds subs,d,aries, affiliates, successors, and assigns "SHIFT4") a to provide a copy of thrs Gateway Servrnces Appl-1— to any third party for the services requested. FUNDS TRANSFER AUTHORIZATION SHIFT4 CORPORATION ("SH IF T4"I ,s autho razed to perform such fu nc tic ns under the Ge Lewey Services Agreement Terms and Conditions including but not I mited to To Ki ng autometetl cleeYinghouse debits to Merchant's or Dealars bank account for the purposes set forth in the Gateway Services Agreement Terms and Conditions THIS AGREEMENT INCLUDING ADDITIONAL FEES) MAY BE AMENDED WITH THIRTY (30) DAYS NOTICE TO MERCHANT. PLEASE SEE SECTION 3.6 AND 23.10 OF THE TERMS AND CONDITIONS SHIFT4 Dealer may sign this Gateway Services Appl—t— ,n lieu of Merchant. In the event Dealer signs th,s appl ,anon ,t. (el represents that all of the information contained herein ,s true and correct, and ;b) shall be responsible to pass through all of the obligations set fcrth,n the Gateway Services Agreement to Merchant pr.v.ded, however, that Dealer shall remain responsible for the obligations of Merchant end shell cause Merchant to comply with the provisions of the Gateway Services Agreement in connection thereof. EARLY TERMINATION F F E If the Merchant terminates this GATEWAY SERVICES AGREEMENT poor to the and of the INITIAL TERM (3 years) or any RENEWAL TERM (2 yearsl for any reason MERCHANT agrees to pay SHIFT4 an account closure fee ("EARLY TERMINATION FEE") as set forth in Section 5.11 of the is the average of the Monthly MONTHLY SERVICE FEES mvorcedsince this Gateway Services Agreement's Effective Date, multiplied by the number of Months remaining in the current Initial Term or Successive Term). MERCHANT agrees that this fee 3 not a penalty, but rather a reasonable estimation of the ebtuel damages SHIFT4 would suffer if SHITT4 were to fall to receive the gateway business for the then current term. MERCHANT agrees that the EARLY TERMINATION FEE shall also be due to SHIFT4 If MERCHANT discontinues submitting Irensectlans for gateway during the INITIAL TERM or any RENEWAL TERM of the AGREEMENT. Notwithstanding the foregoing, the early termination fee will not exceed the maximum amount set forth by applicable law. Paragraph references and capitalized terms not defined in this paragraph are defined In the TERMS AND CONDITIONS at Fhp://w Shrt4-cc Mgataway-terms. MERCHANT AND SHIFT4 AGREE THAT SECTION 24 REQUIRES ALL DISPUTES WITH SHIFT4 TO BE RESOLVED IN BINDING INDIVIDUAL ARBI IRATION —NOT IN A CLASS ACTION, AND NOT IN COURT BEFORE A JUDGE OR JURY. SECTIONS 7 a 8 LIMIT SHIFT4'S LIABILITY AND MERCHANT'S REMEDIES. PLEASE READ THEM, Q DEAW/PRINCIPAW FAOMAPPLICATIBN'SIONANRE DATE © DEAIER/PRINCIPAL;k2 FROM APPLICATION — SIGNATURE DATE M PRINT NAME TITLE PAINT NAME — — TITLE ACCEPTED BY SHIFT4 PAYMENTS, LAC 53245 062612D1g DATE PAGE 1 of 2