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CHASECP Merchant Services*4 Northeastern Boulevard, Salem, NH 03079-1952 *www chasepaymentech.com
<br /> Paymentech Phone (603)896-6000*Fax:(603)896-8715- Merchant—Services@ChasePaymentech.com
<br /> Note: When setting up multi le bank accounts, please co�ll p/ete a separate form for each.
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<br /> Option#1 Z USD USA A, E
<br /> CAD
<br /> Option#2 El (See section A Note section)
<br /> CAN B1 to B3, E
<br /> Option#3 El USD CAN B1 to B3, D3, D4, E
<br /> Option#4 ❑ USD I nt'l C1 to C3, D1, D3, D4, E
<br /> (list country funds are being deposited in
<br /> Option#5 El E)Euro, E:IGBP, El JPY, OAUD, [:1 Euro Bank or SAME as C1 and/or C2, C3, E
<br /> HKID, [:IDKK, EICHF, EJNOK, EJSEK, presentment/settlement currency
<br /> EjNZD, EIZAR
<br /> Option#6❑ DEuro, EIGBP, El JPY, EJAUD, El If DIFFERENT than Settlement C1 and/or C2, C3, Di
<br /> HKID, ODKK, EICHF, [:INOK, EISEK, Currency and/or D2, D4, E
<br /> E:INZD, [:IZAR, DUSID Int'l
<br /> — (list country funds are being deposited in
<br /> Option#7❑ E]Euro, [:IGBP, [:] JPY, EJAUD, 1:1 CAN 81 to B3, D1, D4, E
<br /> HKID, E:)DKK, CICHF, EINOK, EISEK,
<br /> [:INZD, OZAR
<br /> (select only one method of transfer)
<br /> Z ACH Transfer
<br /> (ABA #)
<br /> El Wire Transfer (See Note) (Fedwire#lRouting#)
<br /> ❑ Swift Transfer (See Note)
<br /> IT 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#lRouting#.
<br /> Special Wire Instructions: (60 bytes) I
<br /> Bank Account#- Company Name. (As appears on Bank Account)
<br /> Financial Institution Name
<br /> City: State Zip/Postal Code Country: United States
<br /> Checking OR 0 Savings
<br /> N 04:11. N PROK M
<br /> T :., ra k
<br /> Bi Institution Number,
<br /> I + 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 El Savings
<br /> Rev1 1/18/10 8 New Division/cboo 156
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