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Court <br />g <br />AFFr <br />1 <br />Merrick Bank <br />Merchant Application and Agreement <br />Merchant #: 394750528301 <br />MCC: 7992 <br />MERCHANT NAME (DBA or Trade Nome) <br />SANDRIDGE GOLF CLUB <br />CORPORATE/LEGAI. NAME (i(DifTeraa) <br />INDIAN RIVER COUNTY <br />LOCATION ADDRESS <br />5300 73RD ST <br />CORPORATE ADDRESS (if Different) <br />1801 27TH ST BLDG A <br />CITY — <br />VERO BEACH <br />Mee <br />FL <br />Zp <br />32967 <br />CITY <br />VERO BEACH <br />Stam <br />FL <br />'tip <br />32960 <br />Location Phone <br />(772) 770-5003 <br />Location Fa. <br />(772) 770-5109 <br />Corporate Phone <br />(772) 226-1219 <br />Corporate Fax <br />(772) 770-5331 <br />CONTACT NAME <br />BELA NAGY <br />CONIAC'I'EMAIL AUUIUSS <br />BNAGY@IRCGOV.COM <br />CONTACT PHONE <br />(772) 770-5003 <br />FEDERAL TAX IDI <br />59-6000674 <br />DOES THIS LOCATIONCURRENT).Y TAKE PAYMENT CARDS? ❑Na ®Ye (d yes please provide) <br />HAS MERCHANT OROWNERS/PRINCIPAIS EVER BERN TERMINATED FROM ACCEPTING PAYMENT CARDS <br />FROM ANY PAYMENT NETWORK FOR THIS BUSINESS OR ANY OTHER BUSINESSES/ <br />ElNo 0 Yes (if yes pleaseexplain) <br />PRINCIPLES <br />ZNei f r e y Middle teat( R. n "uSmith SCN <br />%OunersipTrClerk of Circuit <br />HonieAddma: City. <br />Slat. 7tp' Dmeyf Birth <br />„o„,,p,,q„e 7722261500 DLO Stam <br />Emaandarm. smith@clerk.indian-river ..o- <br />Principle 02 Name <br />First - Middle Init Last - '00B: <br />%Ossnn ip. Tile <br />Home Address: City: <br />- State: Zip. bate of Binh. <br />Home Phone - - 03.0(510 <br />Email Address: <br />TYPE OF BUSINESS <br />NATURE. OF BUSINESS <br />0Indnviduvp5oie Proprietorship 0 Pa rtnership❑ Corporation 0 TLC State <br />®Retail 0 ReadwTp ❑ MeiVl'honc Order 0 Intim.❑ Rmtmmmt ❑ Fast Food <br />❑l aging ❑QSR ❑Com.. e 0 Public Sector 0 Petroleum 0 Utility <br />0 Calla- <br />❑Nan Pun Mug Provide 503-C) 0 Private❑ Publicly Traded ❑ Ga anmat <br />1:IBoardR <br />Lagtli oftsmeMbnivm 79 Yeas 0 Manors <br />Seasonal Sale. ❑Yes IDNo If so, please indicate high volume months <br />J ❑ F MO A❑ MO 3❑ J❑ A❑ S 00 NO DO <br />Product a Service bang offal. <br />Method nrAasepta000 (Totals to equal 1011%) 'M'el1°na processing lea tl.-rox swipe <br />transactions must complete the MO/TO <br />creat Cords Swiped 90 % MO/r° 5 % Question. Tara) <br />AmnmI VMC Wiume: $ 2.200.000.00 Monthly Payment Cmd Volume s 183333.00 <br />Ave Ticket S 49.00 High i0+ 1 1500.00 <br />Key Entered 5 % Internet 0 % (URL' ) <br />Machete's URl.(s): <br />Macho. Name to appear on Meanest: ® DBA Nmne 0 Lege Name <br />Odic. <br />DOES MERCIIANT USF. AN INDEPENDENT SERVICER THATSTORES MAINTAINS ORTRANSMITS CARDHOLDER INFORMATION: <br />0 N ® Y.(ifyrs, please Provide') <br />NAME: EMONEY VERSION NUMBER: 4.7 <br />IX)ES MERCHANT USE Api(LFILLMEINT HOUSE TO FULFILL PRODUCT. <br />ID No 0 Ya (fy., <br />NAME PHONE NUMBER: <br />please provide') <br />WAS MERCHANT OR OWNERS/PRINCIPALS EVER FILED BUSINESS BANKRUPTCY and/or PERSONAL BANKRUPTCY <br />_ <br />0 N. ❑ Y. (dyes, please provide) <br />Eipicsauo¢ <br />BANK ACCOUNT LNFORMATION: ❑Checking Account ❑SavingsMeavat Bank Name <br />Attach voided check for the operating account where 05500505 to be deposited <br />Transit (ABA Rautmg). Accmmt/ (DOA)' <br />Contact Phone Y. <br />• By (minding du oho.a refaa ced ter (inti, you are amhm;nng Bank to innlam 0CH debit and credit amuaaaii+to said account <br />SCHEDULE A: VISAIMASTF-RCARD/DISCOVER® DISCOUNT RATES & FEES: <br />CARD FEES: OTHER FEES: <br />You have the option of accepting MasterCard <br />credit cards, Visa credit cards, credit cards issued <br />by Discover. MasterCard signatuiedebit cards <br />(MasterMoney Cards) or Visa signature debit <br />cards (Check Cards), or debit cards issued by <br />Discover. You may elect to accept any or all of <br />these card types for payment If you do not <br />specifically indicate otherwise, your application <br />will be processed to accept ALL MasterCard, <br />Discover, and Visa card types. <br />Elected Visa, Discover, or MC card types YQ[ to <br />accept. <br />INTERCHANGE. (COST) PLUS: <br />Appliation Fa <br />50.00 <br />FCPN1 Fee <br />80.00 <br />• <br />CREDIT: <br />Y. Markup <br />P/1 Markup <br />Meanly Minimum Fee <br />825.00 <br />Chnmebnok Fa <br />815.00 <br />Vim BPS <br />0.15 % <br />80.09F.quirmwnt <br />RaaaPmmmux Ea <br />80.00 <br />Annual PCI Fa <br />8150.00 <br />MC BPS <br />0.15 % <br />80.09 <br />PMotaro Setup Fa <br />80.00 <br />Mote. PCI Fre <br />80.00 <br />Discover BPs <br />0.50 % <br />80.09 <br />Swtenat Fee <br />87.50 <br />EMon s soup Fa <br />80.00 <br />DEBIT: <br />%Markup <br />MMarkup <br />ACI Toe <br />80.00 <br />TAR <br />AvtA Pee <br />°mine Debit <br />0.30 % <br />80.09 <br />FMonev 1 tort Fe <br />80.00 <br />AMEX <br />80,19 <br />Online Debit0.10 <br />% <br />80.09 <br />Won. Monthly Fee <br />80.00 <br />Di <br />80.19 <br />If you currently accept American Express please w re your existing account number on the line provided : if you do not currently <br />and would like to. please cheek the box to apply. <br />American Express (10 digits): <br />accept American Express <br />❑ Apply <br />Site Inspection: <br />Marla ® Owns 0 Rents Landlord: <br />Based upon your review, doer Merchant hint the appropriate facilities, equipment inventory, psnsoanel <br />or permn opera <br />and license 't to m their bu.+inexit <br />❑ No 0 Ya <br />Comments <br />. <br />Building Type 0 Shopping Cnt. 0 OQ¢e Building 0 Industrial Building ElResidence <br />Arm Zonal; 0 Commercial 0 Industrial 0 Residential <br />Square Footage, ❑ 0.500 0 501 - 2530 0 2501 •50(0) 0500i - I Oomh <br />• By signing below. inspector is 0Axtil tap he/she has visited the location and informmon pros+ded is team & cots( <br />Inspector Name SEAN LYNCH Inspector rima Sigmnue <br />Court <br />g <br />