Laserfiche WebLink
CHASE CV. <br /> Merchant Services*4 Northeastern Boulevard, Salem,NH 03079-1952 *www chasepaymentech.com <br /> • <br /> Pallmen't e—ch Phone (603)896-6000*Fax: (603)896-8715*Merchant Services@ChasePaymentech.com <br /> SECTION -PE <br /> ACESS- C0 <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 0 Mr [:3 Ms F] 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 Zi /Postal Code 02184 Country: USA <br /> Email Address (40 bytes) blapides@invoicecloud com <br /> (usemame@domain.com) <br /> Does this contact have a Paymentech Online User ID? E] Yes 0 No If yes, please provide User ID: <br /> Does this User require access to El Reporting El Transaction History E Both Account Masking Z Yes—EINo <br /> For existing merchants–Is this User replacing an individual with Paymentech Online Access? El Yes Ej No <br /> If yes, who? Has this individual left the company? El Yes 0 No <br /> For existing merchants–Is this User's access to be mirrored like another User Paymentech Online Access? <br /> El Yes n No <br /> If yes, who? <br /> Salutation: Check one El Mr. N Ms 0 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 Zi /Postal Code 02184 Country- USA <br /> Email Address (40 bytes) dbowler@invoicecloud.com <br /> (usememe@domain.com) <br /> Does this contact have a Paymentech Online User ID? Ej Yes El No If yes, please provide User ID: <br /> Does this User require access to- El Reporting [I Transaction History Z Both Account Masking N Yes ❑ No <br /> For existing merchants– Is this User replacing an individual with Paymentech Online Access? El Yes E] No <br /> If yes, who? Has this individual left the company? 0 Yes Ej No <br /> For existing merchants– Is this User's access to be mirrored like another User Paymentech Online Access? <br /> El Yes n No <br /> If yes, who? <br /> 1, Robert Lapides President, Government, Utilities verify that the <br /> and Business Services Division <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 Center <br /> ttj re'-: <br /> *(must be signed by Executive or Financial Contact) <br /> 10 158 <br /> Rev1 1/18/10 New Division/cboo <br />