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CHASE C -P <br />Paymentech <br />Merchant Services o 4 Northeastern Boulevard, Salem, NH 03079-1952 * www.chasepaymentech.com • <br />Phone: (603) 896-6000 * Fax: (603) 896-8715 * Merchant—Services@ChasePaymentech.com <br />SECTION.4:-TRANSACTION DIVISION (continued <br />Please check below if applicable: <br />Z Bill Payment (A Bill Payment transaction is a transaction for an ongoing service/billing cycle that is known and agreed upon in <br />advance by the merchant and cardholder. i.e. Membership or Insurance, etc.) <br />Do you stock product? R Yes Z No Do you provide custom orders at time of sale? ❑ Yes No <br />Do you own the product at the time of sale? Z Yes R No <br />Do you drop ship the product? F1 Yes Z No If yes, what %: <br />Are you filling your own merchandise orders? N Yes R No <br />If no, who is your fulfillment service bureau? <br />Fulfillment Contact: Phone #: <br />SECTION SiliCHARGEBACK CONTACT-. (required) idA (mii7a4e'�lsu;:iervisbrl-ane 'w"ho assigns work to., ; MCAs). <br />r.(Reqyired or, retail and Disc6ver) M RQA <br />k (Manager/supervisor- one who assigns work to MRAs) <br />maiie� of faxed, if not participating NOTE: ;,This Oiliact r6iy-receive ariy'e`xbe'ptioh clicurnents'that may n6ed.to ting in Chargeback. <br />Wanag�errient'this vvill'15e�tfie default contact for Cha'rdeb6ck Ma i - ling second contact wilt not be req'aired ) <br />Location: E] Merchant Z Submitter n Fulfillment (check one) If Submitter/Fulfillment, Name: <br />M Mr. Z Mrs. r-1 Ms. First Name: Carolyn Last Name: Ambrose <br />Title: Administrative Assistant Phone #: 781-848-3733 Ext: 231 <br />Fax #: 877-256-8330 Alternate Fax #: <br />Email Address: - Cambrose@invoicecloud.com <br />Address: 30 Braintree Hill Office Park <br />City: Braintree State/Prov: MA _ Zip/Postal Code: 02184 Country: USA <br />Will this contact require access to: Transaction History ❑ Report Center M both Z ? <br />Account Masking for this contact? Z Yes F1 NO <br />Does this contact have a Paymentech Online User ID? E]Yes ®No If yes, provide User ID: <br />(requirbd)'Mibk�4e�&h . ant Chargeba �vho*worki fi <br />LCHAR�3EE§kC-KCONTACT:-­ cW4najjii '6n� <br />(Reguihbd� for ret6il and Discdver).MRA ((Merchant Retrieval nalyst - one Who Works the. re val§)',�-�` <br />Z Same as above (check here if the MCAIMRA Contact is the same as the IQAIMRQA contact) <br />Location: E] Merchant E] Submitter El Fulfillment (check one) If Submitter/Fulfillment, Name: <br />R Mr. F-1 Mrs. ❑ Ms. First Name: Last Name: <br />Title: Phone #: Ext: <br />Fax #: Alternate Fax #: <br />Email Address: <br />Address: <br />City: State/Prov: Zip/Postal Code: Country: <br />Will this contact require access to: Transaction History R Report Center n both [-I ? <br />Account Masking for this contact? r-1 Yes ❑ No <br />Does this contact have a Paymentech Online User ID? FjYes E]No If yes, provide User ID: <br />Rev11/18/10 <br />151 <br />NewDivisionSetup/cboo <br />