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CHASECP Merchant Services 9 4 Northeastern Boulevard, Salem,NH 03079-1952 e www chasepaymentech.com <br /> Paymentech Phone.(603)896-6000•Fax: (603)896-8715•Merchant—Services@ChasePaymentech.com <br /> P. �-M E <br /> N'G' '_ <br /> Z <br /> Q <br /> Who will be submitting transactions to Chase Paymentech? <br /> Z Merchant [] Other Co Name Invoice cloud (i.e fulfillment co.or ECommerce provider) <br /> If known, please provide the Presenter ID # (PID) or Submitter# (SLI) <br /> F1 1. Will you be submitting transactions from a computer system? <br /> What is the name of the manufacturer and model of your computer platform? <br /> What is the name of the manufacturer and model of your modem? 0 internal 0 Exte"mal <br /> Will you be coding to Chase Paymentech specifications? E] Yes Z No <br /> Will you use NetConnect Batch for Connectivity? E] Yes Z No <br /> Will you use NetConnect for connectivity for online authorization only? El Yes Z No <br /> If yes, NetConnect Contact Name Email: <br /> Userld (if existing)- Phone <br /> If applicable, name the software vendor and application you will be using to format your files. <br /> 2. Will you be using the Orbital Payment Gateway? *If this is the first division using the Orbital Payment Gateway,please contact <br /> your Relationship Manager <br /> Primary Contact** Tony Cordova UserlD (if existing) <br /> Address* 642 E Washington St. <br /> City: Brownsville State TX Zip/Postal Code 78520 Country* USA <br /> Phone: 956-542-6825 Email (required) tcordova@invoicecloud corn <br /> *Primary contact must be the merchant contact for security needs. <br /> Auto-Settle Time none El AM or 0 PM To meet 10 ET Host window, this should be set no later than 8pm <br /> to allow Gateway to settle. <br /> Merchant Time Zone. NA Note The Auto-Settle time is based in the merchant time zone. (US time zones only) <br /> Profile Management required? E]Yes or®No Level of access- Ej Merchant or [:] Chain (select one, default is Merchant) <br /> VT Import Functionality? 0 Yes Z No <br /> Auth Recycling? Ej Yes Z No #of Recycle Attempts: (Default is 3) #of Days between attempts <br /> F1 3. Will you be using: [—) Paypal/Verisign El CyberSource <br /> F1 4.Will you be using the iTerminal? (retail divisions only) <br /> Primary Contact*: UserlD (if existing) <br /> Address- <br /> City- State Zip/Postal Code: Country: <br /> Phone, Email (required) <br /> *Primary contact must be the merchant contact for security needs. <br /> To meet 10 ET Host window, this should be set no later than 8prn to allow Gateway to <br /> Auto-Settle Time E] AM or El PM settle. <br /> Merchant Time Zone Note.The Auto-Settle time is based in the merchant time zone. (US time zones only) <br /> Magtek Reader Needed? E]Yes E]No If Debit, PinPad Needed? E]Yes EjNo If Yes, NBS71 OOF] or Verifone SC5000F] <br /> (If Yes, Magtek Readers are purchase only) iTerminal is only certified to utilize the above PinPads and are purchase only) <br /> 6 <br /> Revi 1/18/10 New Division/cboo 154 <br />