Laserfiche WebLink
CHASE 'Qr Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com <br /> Paymentech <br /> Phone (603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com <br /> SECTION 10: REPORT.CENTER AND TRANSACTION HISTORY ACCESS FORM <br /> 1. Please be sure to include the information below for additional contact that requires access to Transaction <br /> History and/or Paymentech Online Report Center. <br /> 2. Report delivery will be web based via Paymentech Online <br /> 3. Please note You, the merchant, are responsible for advising Chase Paymentech of changes in Paymentech <br /> Online contacts Chase Paymentech assumes no responsibility or liability of any kind for Merchant's failure to <br /> advise Chase Paymentech of changes to or elimination of Paymentech Online Users <br /> Please be sure to complete all fields below <br /> Salutation. Check one ® Mr ❑ Ms ❑ Mrs <br /> Name Robert Lapides Title President, GUB Division <br /> Phone#, 781-848-3733 Fax#, 877-256-8330 <br /> Address 30 Braintree Hill Office Park, Suite 303 <br /> City- Braintree State/Prov MA Zip/Postal Code 02184 Country- USA <br /> Email Address (40 bytes) blapides@invoicecloud com <br /> (username@domain.com) <br /> Does this contact have a Paymentech Online User ID? ❑ Yes ® No If yes, please provide User ID, <br /> Does this User require access to ❑ Reporting ❑ Transaction History ® Both Account Masking ® Yes❑ No <br /> For existing merchants— Is this User replacing an individual with Paymentech Online Access? ❑ Yes ❑ No <br /> If yes,who? Has this individual left the company? ❑ Yes ❑ No <br /> For existing merchants—Is this User's access to be mirrored like another User Paymentech Online Access? <br /> ❑Yes ❑ No <br /> If yes, who? <br /> Salutation. Check one ❑ Mr ® Ms ❑ Mrs <br /> Name Deborah Bowler Title VP of Operations <br /> Phone#, 781-848-3733 Fax#. 877-256-8330 <br /> Address 30 Braintree Hill Office Park, Suite 303 <br /> City. Braintree State/Prov MA Zip/Postal Code 02184 Country- USA <br /> Email Address (40 bytes) dbowler@invoicecloud com <br /> (username@domain com) <br /> Does this contact have a Paymentech Online User ID? ❑ Yes ❑ No If yes, please provide User ID <br /> Does this User require access to ❑ Reporting ❑ Transaction History ® Both Account Masking ® Yes ❑ No <br /> For existing merchants— Is this User replacing an individual with Paymentech Online Access? ❑Yes ❑ No <br /> If yes,who? Has this individual left the company? ❑ Yes ❑ No <br /> For existing merchants—Is this User's access to be mirrored like another User Paymentech Online Access? <br /> ❑Yes ❑ No <br /> If yes, who? <br /> For additional Users;:please submit additional forms. <br /> President, Government, Utilities <br /> I, Robert Lapides and Business Services Division verify that the <br /> (Print Name) (Title)' <br /> contact information is accurate, that I have the authority to make such a request and thus it should be used to grant <br /> access for these contacts to access Transaction History and/or the Report tenter <br /> ,(� g t <br /> Signature: 'rC cid{j i. <br /> *(must be signed by Executive or Financial Contact) <br /> 10 <br /> Rev11/18/10 New Division/cboo <br />