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CHASE Q V Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com Paymentech Phone.(603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com SECTION 4: TRANSACTION DIVISION continued Please check below if applicable ® Bill Payment(A Bill Payment transaction is a transaction for an ongoing service/billing cycle that is known and agreed upon in advance by the merchant and cardholder i.e Membership or Insurance, etc.) Do you stock product? ❑ Yes ® No Do you provide custom orders at time of sale? ❑ Yes ® No Do you own the product at the time of sale? ® Yes ❑ No Do you drop ship the product? ❑ Yes ® No If yes, what% Are you filling your own merchandise orders? ® Yes ❑ No If no, who is your fulfillment service bureau? Fulfillment Contact: Phone# SECTION 5: CHARGEBACK CONTACT: (required) IQA (Manager/supervisor—one who assigns work to MCAs) (Required for retail and Discover)MRQA (Manager/supervisor—one who assigns work to MRAs) NOTE. This contact may receive any exception documents that may need to be mailed or faxed, if not participating in Chargeback Management this will be the default contact for Char eback Mailing (second contact will not be required) Location ❑ Merchant ® Submitter ❑ Fulfillment(check one) If Submitter/Fulfillment, Name ❑ Mr ® Mrs ❑ Ms First Name Carolyn Last Name Ambrose Title Administrative Assistant Phone#' 781-848-3733 Ext: 231 Fax#- 877-256-8330 Alternate Fax#' Email Address Cambrose@invoicecloud corn Address 30 Braintree Hill Office Park City- Braintree State/Prov MA Zip/Postal Code 02184 Country- USA Will this contact require access to Transaction History ❑ Report Center ❑ both ® ? Account Masking for this contact? ® Yes ❑ NO Does this contact have a Paymentech Online User ID? ❑Yes ®No If yes, provide User ID- CHARGEBACK CONTACT: (required) MCA (Merchant ChargebackAnalyst—one who works the chargeback's) (Required for retail and Discover)MRA ((Merchant Retrieval Analyst—one who works the retrievals ® Same as above (check here if the MCA/MRA Contact is the same as the IQA/MRQA contact) Location ❑ Merchant ❑ Submitter ❑ Fulfillment(check one) If Submitter/Fulfillment, Name ❑ Mr ❑ Mrs. ❑ Ms First Name Last Name Title. Phone#- Ext: Fax#- Alternate Fax#* Email Address Address City- State/Prov Zip/Postal Code Country- Will this contact require access to Transaction History ❑ Report Center ❑ both ❑ ? Account Masking for this contact? ❑ Yes ❑ No Does this contact have a Paymentech Online User ID? ❑Yes ❑No If yes, provide User ID Rev11/18/10 3 NewDivisionSetup/cboo