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Please acknowledge your receipt of these instructions and guidelines and your agreement to comply therewith. <br />Agreed and Accepted by: <br />County of Indian River — Board of County Commissioners <br />MERCHANT LEGAL NAME (Print or Type) <br />1801 27th St., Vero Beach, FL 32960 <br />A <br />By, Name, Title (Print or Type) <br />aa r�//�� a <br />DateMar`di 9)& 1 ao I / <br />Agreed and Accepted by: <br />Paymentus Corporation <br />3455 Peachtree Rd NE 5th Fl, Atlanta, GA 30326 <br />.r cna:r. <br />B :. . ype) r <br />g0.41121211: <br />`�/mil <br />y (authorized signature) <br />Ire <br />By, ame, Title rint o)� <br />Date <br />Vey/ <br />APPROVED AS TO FORM; <br />AND LEGAL. SUFFICIENCY <br />BY <br />WILLIAId'K. DEBRAAL <br />DEPUTY COUNTY ATTORNEY <br />Attest: Jeffrey R. Smith, Clerk of <br />Circuit Court and Comptroller <br />Deputy Clerk <br />Agreed and Accepted by: <br />PAYMENTECH, LLC for itself and on behalf of <br />JPMORGAN CHASE BANK, N.A. <br />By: <br />Print Name: <br />Title: <br />Date: <br />Address: 4 Northeastern Boulevard, Salem, NH 03079 <br />INTERNAL PAYMENTECH USE PDF <br />Merchant Name: County of rndiao River— Board of County Commissioners Page 4 of 4 Paymentech Contract No..000160 <br />