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CHASEMerchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com. <br /> PaymeIntech Phone.(603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com <br /> SECTION 8: PROCESSING METHOD continued <br /> ❑5. Will you be using a Point-of-sale terminal (US & Canada only) or Point-of-Sale software? <br /> Point of Sales Software: <br /> POS/Software Name Host Capture ❑ Terminal Capture ❑ <br /> Connectivity- Dial ❑ NetConnect❑ (If NetConnect see requirements below) <br /> If NetConnect: Where is your software hosted/configured? Corporate location❑ or Division location❑ <br /> NetConnect Contact Name Email address <br /> Userld if existing Phone <br /> PIN Pad Type and quantity?(for PIN BASE DEBIT Only) Quantity- <br /> Is PIN Pad Existing ❑ or PIN Pad Purchase Needed❑ <br /> Injection—Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key?❑ <br /> Who will be injecting the Encryption Key into your PIN Pad? Please select one below <br /> ❑ Chase Paymentech Solutions ❑ Other Vendor Name <br /> Equipment/Terminals. <br /> Will you ❑ Purchase? ❑ Rent? (US Only) If purchase or rent, date needed by, <br /> ❑ Use existing equipment? ❑Yes ❑ No Terminal quantity? Printer quantity? <br /> Terminal/Equipment Type Printer Type <br /> Host Capture ❑ Terminal Capture ❑ <br /> Connectivity, Dial ❑ NetConnect ❑ Wireless ❑ (If NetConnect see requirement below) <br /> NetConnect Contact Name Email address <br /> Userld if existing Phone <br /> PIN Pad Type and quantity? (for PIN BASE DEBIT Only) Quantity, <br /> Is PIN Pad Existing ❑ or PIN Pad Purchase Needed❑ <br /> Injection—Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key? ❑ <br /> Who will be injecting the Encryption Key into your PIN Pad? Please select one below- <br /> ❑ Chase Paymentech Solutions ❑ Other Vendor Name <br /> Store Phone#, Terminal Line Phone#, Dial Out Prefix (9,8,5). <br /> Customer Service Phone# (if different then Store Phone#) <br /> Equipment/Kits/Imprinters Ship To Address(if different than store Attention to <br /> location)Please ensure a contact will be available to accept shipment: <br /> Default will be Store Manager <br /> Street Address <br /> City- State/Prov Zip/Postal Code Country, <br /> Ship to contact's phone#- Ship to contact's email <br /> Store Opening Date Special Requirements <br /> Do you require a "re-program" kit? (overlay, quick reference guide, etc) Yes❑ No❑ <br /> Do you require an Imprinter? ❑Yes ❑No Type of Imprinter required: With Dater❑ or Without Dater❑ <br /> Do you require an Imprinter Plate? ❑Yes ❑No <br /> Do you require a Welcome Kit? (this includes sales drafts, credit drafts, etc) Yes❑ No❑ <br /> 7 <br /> Rev11/18/10 New Division/cboo <br />