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CHASE 6.) <br />Paymentech <br />Merchant Services # 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 C:: -FINAL DESTINATION BANK <br />Account Where Your Funds are Deposited <br />C1 Swift Code: (8 to 11 bytes) <br />C2 Sort Code: (Required in Great Britain Only) <br />C3 IBAN/Bank Account # <br />Company Name: (As appears on Bank account) <br />Financial Institution Name: <br />City: State/Province: <br />Special Wire Instructions: (60 bytes) <br />Postal Code: Country: <br />Sectlbii'D:',INTERMEDIARY/CLEARIN'G,BANK ACCOUNT INFORMATION <br />oifi;�joi;ij�f�rough J.P. Chase in London, is n-' uired. Complete. Section "C" <br />N" not req' on Y. <br />{Nate: —Pni'l De N <br />D1 <br />Swift Code: (8 to 11 bytes) <br />-T--Fj <br />D2 Sort Code: (Required in Great Britain Only) <br />D3 Wire Transfer: (USA Only) <br />(Routing #) <br />D4 Financial Institution Name: <br />City: State/Province: Postal Code/Zip: <br />Country: <br />Special Wire Instructions: (60 bytes) <br />ot <br />"On behalf of County of Indian River Board of County 1, Bob Solari <br />represent and warrant <br />Commissioners <br />(Merchant Legal Name) (Print Name) <br />that I have the authority to add banking information and I verify that the above banking information is accurate and should be used to <br />transfer funds accordingly." <br />Board of County <br />Commissioners <br />Authorized Signature* Title <br />Date <br />(must oe signea ny izxecutive or t-inanciat uonract) <br />Note: In order to process this request, please attach an original voided check (starter check or bank <br />statements not applicable) or a bank letter of verification. <br />--------------------------------------------------------------------------------------------------------------------- <br />A TTA CH VOIDED CHECK HERE <br />------------------------------------------------- -------------------------------------------------------------------- <br />Rev 11/18/10 9 New Division/cboo 157 <br />