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20 <br />E <br />(+ <br />Merrick Bank <br />Merchant Application and Agreement <br />Anent #: <br />Merchant #• 394750528301 <br />MCC: 7992 <br />MERCHANT NAME. (DIM orlmrk Name) <br />SANDRIDGE GOLF CLUB <br />CORPORATE/LEO/AL NAME (if Different) <br />INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS <br />LOCATION ADDRESS <br />5300 73RD ST <br />CORPORATE ADDRESS (if INiferentl <br />1801 27TH ST BLDG A <br />CRY <br />VERO BEACH <br />Sae <br />FL <br />Zip <br />32967 <br />CITY <br />VERO BEACH <br />SWIG <br />FL <br />Zip <br />32960 <br />fixation Phone <br />(772) 770-5003 <br />Location Fax <br />(772)770-5109 <br />Caprate Phone <br />(772) 226-1219 <br />Corporate Fos <br />(772)770-5331 <br />CONTACT NAME <br />BELA NAGY <br />COYfACfi•:YCULADDRESS <br />BNAGY@IRCGOV.COM IRCGOV.COM <br />CONTACT PHONE. <br />(772) 770-5003 <br />Fl7)IIRALTAX ID* <br />59-6000674 <br />DOES THIS LocAncN CURRENTLY TAKE PAYMIINT CARDS? ❑No ® Yes brines please provide) <br />IIAS MIRCHANT OR OUNIR.Sa7UNCIP.\I.S EVER BEEN 1ERMINATL•1) FROMACCERING PAYMENT CARDS <br />FROM ANY PAYMENT NET\'ORK FOR TIUS BUSINESS OR ANY O771ER BUSIMSSES' <br />KIN° 0 Yes (if ms pl©seesptrinl <br />TYPE OF BUSINESS <br />MATURE OF BUSINESS <br />❑ndividual/Sok Proprietorship 0 Patine, dip 0 Corporation 0 LLC sate: <br />® Retail a Rdail wlfip ❑hiriUPhme Order 0 Same 0 Rm.)m1m 0 Fon Food <br />❑144atS ❑QM( D"' e 0 Public Seam ❑ Parole= ❑ Unlit. <br />❑ Other <br />❑NonRonit(KW Provide )50)-C) 0 hit. ❑Publicly Trades/ ® Oo mmen <br />❑BpmJ Rut/Operated <br />Length pftimein Muiueee: 79 Yem1 0 Monde, <br />SA.'❑Yes ❑No If so, picric indicate highh)(plume months <br />J ❑ F❑ M❑ AD MO 1❑ J❑ A❑ S❑ o❑ No D❑ <br />Ptd rorsanieebeingoffered: <br />ma hod of Acceptance: (TenbaeynlI0O%) •htaeluntspoeccwmg acoaaTtn:an;pe <br />nransnaions mud unapt&t eh1O/tO <br />crdit Ecru swipod: 90 Marro 5 % Qtr:+mnoetm.r) <br />AmtudVMC Volume: S 2,717,062.00 !Monthly Pnm..ncardvoltate:s 226421.00 <br />AmeriennEeprasVolume: s 226421.00 _ <br />Key Entered: 5 .. bW0t: 0 % (URL. 1 <br />Ave. Tukees 43.00 uighMad: s 2600.00 <br />htcrchnd's URLs : <br />() <br />Machan Name loappa on Sideman: ❑ UBAName ❑ I.e • 1 Name <br />1.a <br />OrLr <br />DOESMERCIIANf I'SE AN INDIPFNDIMSI:RVICER THAT STORES MAINTAINS OR TRANSMITS CARDHOLDER INFORMATION: <br />❑No ® ¥n(if yes. pleo.e provide:) <br />NAME. EMONEY VERSIONNUMBIS: 4.7 <br />DOES MERCHANT I *SE AEULFILLMENT 11M*SF. TO FI R.FILLPROD; !CT: <br />(ElNo Yes (if ) <br />NAME: PHONE NUMBER: <br />ya please pm)('ide: <br />IIA$ MERCHANTOlt OWNFItSSWUNCIPALS'writ FILED PIUSINF.S$BANKRI A and%or PERSONAL BANKRUPTCY <br />®No Yes (if yes, please poeide ) <br />Fap*rrnion <br />0 <br />BANK ACCOUNT INFORMATION: ®CA Rig Aosnud ❑U,ingsAcp°' BaohName. TD BANK <br />Misch voided check for the operating account where fonds are to be deposited <br />Tramp Y (ABA Rona )1. Account Y (DPA( <br />Comet Phone Y: <br />• By pmnidird the above referenced Reformation. you are luaarning Bank m;mhiak ACH debit and credit tnnwlimesto rid account <br />SCHEDULE A: VISA/111ASTERCARDIDISCOVERB/AMERICAN EXPRESS DISCOUNT RATES & FEES: <br />CARD FEES: OTHER FEES: <br />You have the option of accepting MasterCard <br />credit cards, Vasa credit cards, American Express <br />credit cards, credit cards issued by Discover, <br />MasterCard signnntrc debit cards (MasterMoney <br />Cards) or Visa signature debit cards (Check <br />Cards). or debit cards issued by Discover. You <br />may elect to accept any or all of these card types <br />for payment If you do not specifically indicate <br />otherwise, your application will be processed to <br />accept ALL MasterCard. American Express. <br />Discover, and Visa card types. <br />Elected Visa. Discover, American Expres or <br />MasterCard card types )VDS to accept: <br />INTERCHANGE (COST) PLUS: <br />Appheadow Fee <br />$0.00 <br />ECP Net Fee <br />50.00 <br />CREDIT: <br />N-hbrtop <br />PA Markup <br />Mornhk Mimmun Fee <br />S0.00 <br />(as,,..,gork Foe <br />515.00 <br />VS BPS <br />0.15 es <br />S0.09 <br />Equipment Rrnmxrammhm pee <br />50.00 <br />Amnat pm F'« <br />S 150.00 <br />MC BPS <br />0.15 n <br />S0.09 <br />Money Sentp Fee <br />50.00 <br />htmdh. act Fee <br />50.00 <br />DISC BPs <br />0.50 is <br />S0.09 <br />Stammer pow <br />S7.50 <br />AMEX BPs <br />0.25 w <br />50.09 <br />All IFre <br />50.00 <br />DEBIT/ PIN: <br />% Mark'up <br />NI Startup <br />,..„ , (Ire Foe <br />52.00 <br />Omine/ Online Debet <br />0.30 +; <br />50.09 <br />Morley Monthh pee <br />S0.00 <br />She Inspection: <br />htaeMra: El 0,,, ❑ Rata Landlord:Based <br />upon your mien', does Merchant am Weave the appropriate facilities. equipment. imwntoiy. personnel <br />and license or permit to operate their business? <br />0 N In Ye' <br />Conned, - <br />BuiIdu,g Tyle: 0 Shopping Cdr. 0 Office Buikling 0 hdumidnuildirpi 0 Residence <br />Ana ?,rad: a Coawecial 0 Industrial 0 RCIAdartill <br />Square Footage: ❑ os(r) NI 301 -tiO)) ❑ :$al - Horn ® SON -USW. <br />• BY sinning. below. insoowtor is cenif'ine tic/she has visited this location and information provided is (ng. & consent <br />Inspector Nano: SEAN LYNCH Tamen. Dote: Signature: <br />20 <br />