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CHASE 0-;
<br /> ® Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com
<br /> a" ec Phone-(603)896-6000•Fax:(603)896-8715• Merchant_Services@ChasePaymentech.com
<br /> Note: When setting up multiple bank accounts,please complete a separate form for each.
<br /> SECTION 9: BANK ACCOUNT INFORMATION
<br /> Check only one Settlement Currency in which we Deposit Complete all sections
<br /> of the 7 options will fund to you (Country where your Bank Acct listed:
<br /> below Resides
<br /> Option#10 USD USA A, E
<br /> See section A Note section)
<br /> Option#2❑ CAD CAN B1 to B3, E
<br /> Option#3❑ USD CAN B1 to B3, D3, D4, E
<br /> Option#4❑ USD Int'I C1 to C3, D1, D3, D4, E
<br /> (list country funds are being deposited in)
<br /> Option#5❑ ❑Euro, ❑GBP, ❑JPY, ❑AUD, ❑ Euro Bank or SAME as C1 and/or C2, C3, E
<br /> HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK, presentment/settlement currency
<br /> ❑NZD, ❑ZAR
<br /> Option#6❑ ❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑ If DIFFERENT than Settlement C1 and/or C2, C3, D1
<br /> HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK, Currency and/or D2, D4, E
<br /> ❑NZD, ❑ZAR, ❑USD Int'I
<br /> list country funds are being deposited in)
<br /> Option#7❑ ❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑ CAN B1 to B3, D1, D4, E
<br /> HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK,
<br /> ❑NZD, ❑ZAR
<br /> Section A: US BANK ACCOUNT INFORMATION
<br /> (select only one method of transfer)
<br /> ®ACH Transfer 1 2 1 0 0 0 2 4 8 (ABA#)
<br /> ❑Wire Transfer (See Note) (Fedwire#/Routing#)
<br /> ❑Swift Transfer (See Note) (Swift Code (8 to 11 bytes)
<br /> Please Note. Swift code is required if your division is located outside of the US or Canada and is settling funds in USD
<br /> Wire transfer requires both ACH ABA#and Fedwire#/Routin #
<br /> Special Wire Instructions. 60 bytes)
<br /> Indian River County Board
<br /> Bank Account#' Company Name (As appears on Bank Account) of County Commissioners
<br /> Financial Institution Name.
<br /> City- Orlando State. FL Zip/Postal Code 32803 Country- United States
<br /> ®Checking OR ❑ Savings
<br /> Section B: CANADIAN BANK ACCOUNT INFORMATION: Transfer Method EFT Only
<br /> 131 Institution Number EFT Branch Transit Number
<br /> B2 Swift Code (8 to 11 bytes) (required if settlement is USD)
<br /> B3 Bank Account# Company Name (As appears on Bank Account)
<br /> Financial Institution Name
<br /> City- Province Postal Code Country- Canada
<br /> ❑Checking OR ❑ Savings
<br /> 8
<br /> Rev11/18/10 New Division/cboo
<br /> J
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