HomeMy WebLinkAbout2016-105A Biller Agreement
1.License Grant&Restrictions.Subject to execution by Biller of the invoice Cloud Biller Order Form incorporating this Agreement,imroice
Cloud hereby grants Biller a non-exclusive, non-transferable, worldwide right to use the Service described on the Biller Order Form until
termination as provided herein,solely for the following purposes,and specifically to bill and receive payment from Biller's own customers,for
Services that are referenced in the Biller Order Form All rights not expressly granted to Biller are reserved by Invoice Cloud and its licensors.
Biller will provide to invoice Cloud all Biller Data generated for Biller's Customers. Unless otherwise expressly agreed to in writing by Invoice
Cloud to the contrary, Invoice Cloud will process all of Biller's Customers' Payment Instrument Transactions requirements related to the Biller
Data and will do so via electronic data transmission according to our formats and procedures for each electronic payment type selected in the
Biller Order Form. In addition,Biller will sign all third party applications and agreements required for the Service including without limitation
payment and credit card processing agreements and merchant agreements. For invoice types listed on the Order Form (e.g. real estate taxes,
utility bills,birth certificates,parking tickets,event tickets,etc). Biller will not use the credit card processing.ACH or check processing of any
bank, payment processor, entity, or person, other than Invoice Cloud via electronic data transmission or the authorization or processing of
Biller's Customers' Payment Instrument Transactions for each electronic payment type selected in the Biller Order Form throughout the term
of this Agreement.Not withstanding the forgoing, biller is permitted to utilize the existing bank for auto-pay ACH transactions
Biller shall not:(i)license,sublicense, sell,resell, transfer,assign, distribute or otherwise commercially exploit or make available to any third
party the Service in any way; (ii) modify or make derivative works based upon the Service, (iii) Recreate, "frame" or"mirror" any portion of
the Service on any other serer or wireless or Internet-based device; (iv) reverse engineer or access the Service, or (v) copy any features,
functions or graphics of the Service
2. Privacy & Security. Invoice Cloud's privacy and security policies may be viewed at littp.Hwww.invoicecloud.com/pi-ivacv.11tnll. Invoice
Cloud reserves the right to modify its privacy and security policies in its reasonable discretion from time to time which modification shall not
materially adversely impact such policies Invoice Cloud will maintain compliance with current required Payment Card industry(PCI)standards
and Cardholder information Security standards.
3.Account Information and Data. Invoice Cloud does not and will not own ally Customer Data, in the course of providing the Service Biller,
not Invoice Cloud, shall have sole responsibility for the accuracy, quality, integrity, legality, and reliability of, and obtaining the intellectual
property rights to use and process all Customer Data. In the event this Agreement is terminated, Invoice Cloud will make available to Biller a
file of the Customer Data within 30 days of termination of this Agreement(or at a later time if required by applicable law), if Biller so requests
at the time of termination. Invoice Cloud reserves the right to remove and/or discard Customer Data with 30 days notice except as prohibited
by applicable law or in the event of exigent circumstances which makes prior notice impracticable, and in which case,notice will be provided
promptly thereafter.
4. Confidentiality / Intellectual Property Ownership. Invoice Cloud agrees that it may be furnished with or otherwise have access to
Customer Data that the Biller's customers considers being confidential Invoice Cloud agrees to secure and protect the Customer Data in a
manner consistent with the maintenance of Invoice Cloud's own Confidential Information, using at least as great a degree of care as it uses to
maintain the confidentiality of its own confidential information,but in no event use less than conlnlercially reasonable measures. Invoice Cloud
will not sell, transfer, publish, disclose, or otherwise make available any portion of the Customer Date to third parties, except as required to
perform the Services under this Agreement or otherwise required by applicable law
Invoice Cloud(and its licensors,where applicable)owns all right,title and interest, including all related Intellectual Property Rights, in and to
the Invoice Cloud Technology, the Content and the Service and any enhancement requests, feedback, integration components, suggestions,
ideas, and application programming interfaces, recommendations or other information provided by Biller or any other party relating to the
Service In the event any such intellectual property rights in the invoice Cloud Technology, the Content or the Service do not fall within the
specifically enumerated works that constitute works made for hire under applicable copyright laws or are deemed to be owned by invoice
Cloud,Biller hereby irrevocably,expressly and automatically assigns all right,title and interest worldwide in and to such intellectual property
rights to Invoice Cloud The Invoice Cloud name, the invoice Cloud logo, and the product names associated with the Service are trademarks
of Invoice Cloud or third parties, and no right or license is granted to use them
Biller agrees that during the course of using or gaining access to the Service (or components thereof) it may be furnished with or otherwise
have access to information that Invoice Cloud considers to be confidential including bUt not limited to invoice Cloud Technology, customer
and/or prospective customer information, pricing and financial information of the parties which are hereby deemed to be Invoice Cloud
Confidential Information, or any other information by its very nature constitutes information of a type that any reasonable business person
would conclude was intended by Invoice Cloud to be treated as proprietary, confidential, or private (the "Confidential Information"). Biller
agrees to secure and protect the Confidential Information in a manner consistent with the maintenance of Invoice Cloud's rights therein, using
at least as great a degree of care as it uses to maintain the confidentiality of its own confidential information, but in no event use less than
reasonable efforts. Biller will not sell transfer, publish, disclose, or otherwise make available any portion of the Confidential Information of
the other party to third parties(and will ensure that its employee and agents abide by the requirements hereof), except as expressly authorized
in this Agreement or otherwise required by applicable law
Biller Agreement Rev 3.0
The complete Biller.Agreement includes the Biller Order Form.the Online Terms and Conditions and this Agreement
Biller Agreement
5. Billing and Renewal. Invoice Cloud fees for the Service are provided on the Biller Order Form Invoice Cloud's fees are exclusive of all
taxes, levies, or duties imposed by taxing authorities, Invoice Cloud may assess and/or collect such taxes; levies, or duties against Biller and
Biller shall be responsible for payment of all such taxes, levies,or duties,excluding only United States(federal or state)taxes based solely on
Invoice Cloud's income. All payment obligations are non-cancellable and all amounts or fees paid are non-refundable. Unless Invoice Cloud in
its discretion determines otherwise, all fees will be billed in U S dollars. If Biller believes Biller's bill or payment is incorrect, Biller must
provide written notice to Invoice Cloud within 60 days of the earlier of the invoice date, or the date of payment, with respect to the amount in
question to be eligible to receive an adjustment or credit; otherwise such bill or payment is deemed correct. Invoice Cloud reserves the right to
modify any pricing with respect to fees owed by the Biller upon thirty days written notice to Biller based on increases incurred by Invoice
Cloud on fees,assessments,and the like from credit card processers, bank card issuers,payment associations, ACH and check processers
6. Term and Termination. The initial term of this Agreement shall be for a period of one (1) year ("Initial Term") commencing on the
Effective Date on the Biller Order Form and will renew for each of additional successive one (1) year terns ("Renewal Term") unless
terminated as set forth herein This Agreement may be terminated by either party effective at the end of the Initial or any Renewal Term by
such party providing written notice to the other party of its intent not to renew no less than sixty (60)days prior to the expiration of the then-
current term. Additionally, this Agreement may be terminated by either party with cause in the event of a material breach of the terns of this
Agreement by the other party and the breach remains uncured for a period of 30 days following receipt of written notice by the breaching party
For example, any unauthorized use of the Invoice Cloud Technology or Service by Biller, or its authorized users will be deemed a material
breach of this Agreement. Upon any early termination of this Agreement by Invoice Cloud as a result of the breach, Biller shall remain liable
for all fees and charges incurred,and all periodic fees owed through the end of the calendar month following the effective date of termination.
Upon any termination or expiration of this Agreement, Biller's password and access will be disabled and Biller will be obligated to pay the
balance due on Biller's account computed in accordance with the Charges and Payment of Fees section above Biller agrees that invoice Cloud
may charge such unpaid fees to Biller's Debit Account or credit card or otherwise bill Biller for such unpaid fees.
7.Invoice Cloud Responsibilities.Invoice Cloud represents and warrants that it has the legal power and authority to enter into this Agreement.
Invoice Cloud warrants that the Service will materially perform the functions that the Biller has selected on the Order Form under normal use
and circumstances and that. Invoice Cloud shall use commercially reasonable measures with respect to Customer Data to the extent that it
retains such, in the operation of the Service, provided that the Biller shall maintain immediately accessible backups of the Customer Data. In
addition, invoice Cloud will, at its own expense, as the sole and exclusive remedy with respect to performance of the Service, correct any
Transaction Data to the extent that such errors have been caused by Invoice Cloud or by malfunctions of invoice Cloud's processing systems.
S.Limited Warranty EXCEPT AS PROVIDED iN SECTION 7,THE SERVICES AND ALL CONTENT AND TRANSACTION DATA IS
PROVIDED WiTHOUT ANY EXPRESS, OR IMPLIED WARRANTY, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED
WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND ALL OTHER WARRANTIES ARE
HEREBY DISCLAIMED TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW BY INVOICE CLOUD AND iTS
LICENSORS AND PAYMENT PROCESSORS INVOICE CLOUD AND ITS LICENSORS AND PAYivIENT PROCESSORS DO NOT
REPRESENT OR WARRANT THAT(A)THE USE OF THE SERVICE WILL BE UNINTERRUPTED OR ERROR-FREE,OR OPERATE
IN' COMBINATION WITH ANY OTHER HARDWARE, SOFTWARE, SYSTEM OR DATA, (B) THAT THE SERVICE WILL NOT
DELAY 1N PROCESSING OR PAYING, OR (C) THE SERVICE WILL MEET REQUIREiMENTS WITH RESPECT TO SIZE OR
VOLUME. Invoice Cloud's service may be subject to limitations,delays, and other problems inherent in the use of the internet and electronic
communications. invoice cloud is not responsible for any delays, delivery failures, or other damage resulting from such problems. Biller
represents and warrants that Biller has not falsely identified itself nor provided any false information to gain access to the Service and that
Biller's billing information is correct.
9. Biller's Responsibilities. Biller represents and warrants that it has the legal power and authority to enter into this Agreement. Biller is
responsible for all activity occurring under Biller's accounts and shall abide by all applicable laws, and regulations in connection with Biller's
and/or its customers' and a payers' use of the Service, including those related to data privacy, communications, export or import of data and
the transmission of technical,personal or other data. Biller shall (i)notify Invoice Cloud immediately of any unauthorized use of any password
or account or any other known or suspected breach of security; (ii) report to Invoice Cloud and immediately stop any copying or distribution
of Content that is known or suspected to be unauthorized by Biller or Biller's Users.and(iii)obtain consent from Biller's customers and payers
to receive notifications and invoices from Invoice Cloud Invoice Cloud is not responsible for any Biller postings in error due to delayed
notification from credit card processor..ACH bank and other related circumstances
Biller is required to ensure that it maintains a fair policy with regard to the refund, return or cancellation of services and adjustment of
Transactions.Biller is also required to disclose a refund,return or cancellation policies to invoice Cloud and any applicable payment processors
and Biller's Customers,as requested. Any change in a return/cancellation policy must be submitted to Invoice Cloud,in writing, not less than
21 days prior to the effective date of such change If Biller allows or is required to provide a price adjustment, or cancellation of services in
connection with a Transaction previously processed, Biller will prepare and deliver to Invoice Cloud Transaction Data reflecting such
refund/adjustment within 2 days of resolution of the request resulting in such refund/adjustment The amount of the refund/adjustment cannot
exceed the amount shown as the total on the original Transaction Data. Biller may not accept cash or any other payment or consideration from
a Customer in return for preparing a refund to be deposited to the Customer's account; nor may Biller give cash/check refunds to a Customer
in connection with a Transaction previously processed, unless required by applicable law
Biller Agreement Rev 3.0
The complete Biller Agreement includes the Biller Order Form,the Online Terms and Conditions and this Agreement
;: 2
12
Biller Agreement
10. Indemnification. Invoice Cloud shall indemnify and hold Biller; employees; attorneys, and agents, harmless from any losses, liabilities,
and damages(including;without limitation,Biller's costs,and reasonable attorneys' fees)arising out:(i)failure by Invoice Cloud to implement
commercially reasonable measures against the theft of the Customer Data; or(ii) its total failure to deliver funds processed by Invoice Cloud
as required hereunder(which relates to payments due from Invoice Cloud for Transaction Data) This indemnification does not apply to any
claim or complaint relating to Biller's failure to resolve a payment dispute concerning debts owed to Biller or Biller's negligence or willful
misconduct or violation of any applicable agreement or law
11.Fees.
Invoice Cloud will not charge fees related to the initial setup, initial implementation and personalization of its standard Service unless a fee is
included in the Biller Order Form Invoice Cloud will charge the Biller or payer fees as provided in the Biller Order Form. In addition,Invoice
Cloud reserves the right to charge for changes to the setup; implementation or personalization performed after the completion of initial setup
or implementation and any other requested work or changes including the following services, at its then standard rates
• new file/biller set up
• template changes
• custom reports and other custom development
• new bill printer support
• invoice file format changes resulting in revision of integration/data translation
• re-implementation of a site/system and/or new billing system
• payment file revisions
• loading pdfs and importing/loading invoices
• conversion of biller customer registrations/passwords(post initial implementation)
• balance forward of invoices
• other out of scope services
12. Limitation of Liability. INVOICE CLOUD'S AGGREGATE LIABILITY SHALL BE UP TO AND NOT EXCEED THE AMOUNTS
ACTUALLY PAID BY AND/OR DUE FROM BILLER IN THE TWELVE (12) MONTH PERIOD IMiMEDIATELY PRECEDING THE
EVENT GIVING RISE TO SUCH CLAiM. IN NO EVENT SHALL INVOICE CLOUD AND/OR ITS LICENSORS BE LIABLE TO
ANYONE FOR ANY INDIRECT, PUNITIVE, SPECIAL, EXEMPLARY, INCIDENTAL, CONSEQUENTIAL (INCLUDING LOSS OF
DATA, REVENUE, PROFITS, USE OR OTHER ECONOi\MIC ADVANTAGE) ARISING OUT OF, OR iN ANY WAY CONNECTED
WITH THIS SERVICE, EVENT IF THE PARTY FROM WHICH DAMAGES ARE BEING SOUGHT OR SUCH PARTY'S LICENSORS
HAVE BEEN PREVIOUSLY ADVISED OF THE POSSIBILITY OF SUCH DAiivIAGES.Certain states and/or jurisdictions do not allow the
exclusion of implied warranties or limitation of liability for incidental, consequential or certain other types of damages, so the exclusions set
,forth above may not apply to Biller
13. Export Control. The Biller agrees to comply with United States export controls administered by the U S Department of Commerce, the
United States Department of Treasury Office of Foreign Assets Control,and other U.S agencies
14. Notice. Either party may give notice by electronic mail to the other party's email address (for Biller, that address on record on the Biller
Order Form, or by written communication sent by first class mail or pre-paid post to the other party's address on record in Invoice Cloud's
account information for Biller, and for Invoice Cloud,to Invoice Cloud, Inc., 30 Braintree Hill Office Park, Suite 303, Braintree, MA 02184
Attention:Client Services. Such notice shall be deemed to have been given upon the expiration of 48 hours after mailing or posting(if sent by
first class mail or pre-paid post)or 12 hours after sending(if sent by email) v
15.Assignment.This Agreement may not be assigned by either party without the prior written approval of the other party,but may be assigned
without such party's consent to(i)a parent or subsidiary,(it)an acquirer of assets,or(iii)a successor by merger Any purported assignment in
violation of this section shall be void
16. insurance.
Invoice Cloud agrees to maintain in full force and effect during the term of the Agreement,at its own cost,the following coverages.
a. Commercial General or Business Liability Insurance with minimum combined single limits of One Million (S1,000,000) each
occurrence and Two i\,iillion(52,000,000)general aggregate
b. Umbrella Liability Insurance with minimum combined single limits of Five Million (55,000,000) each occurrence and Five Million
(55,000,000)general aggregate.
Biller Agreement Rev 3.0
The complete Biller Agreement includes the Biller Order Form,the Online Terms and Conditions and this Agreement
13
Biller Agreement
c Automobile Liability Insurance with nuninuun combined single limits for bodily injury and property damage of not less than One
Million(S 1,000,000)for any one occurrence,with respect to each of the Invoice Cloud's owned,hired or non-owned vehicles assigned
to or used in performance of the Services
d. Errors and Omissions Insurance(Professional Liability and Cyber Insurance) with limits of liability of at least One Million Dollars
(S 1,000,000)per claim and in the aggregate.
17. Immigration Laws. For Services performed within the United States, Invoice Cloud will assign only personnel who are either citizens
of the United States or legally eligible to work in the United States. Invoice Cloud represents and warrants that it has complied and will comply
with all applicable immigration laws with respect to the personnel assigned to the Biller
18. General. With respect to agreements with municipalities, localities or governmental authorities, this Agreement shall be governed by the
law of the state wherein such municipality, locality or governmental authority is established, without regard to the choice or conflicts of law
provisions of any jurisdiction. With respect to Billers who are not with municipalities, localities or governmental authorities, this Agreement
shall be governed by Massachusetts law and controlling United States federal law, without regard to the choice or conflicts of law provisions
of any jurisdiction. No text or information set forth on any other purchase order, preprinted form or document(other than an Biller Order, if
applicable)shall add to or vary the terms and conditions of this Agreement. If any provision of this Agreement is held by a court of competent
jurisdiction to be invalid or unenforceable,then such provision(s)shall be construed,as nearly as possible,to reflect the intentions of the invalid
or unenforceable provision(s),with all other provisions remaining in full force and effect.No joint venture,partnership,employment,or agency
relationship exists between Biller and Invoice Cloud as a result of this agreement or use of the Service The failure of either party to enforce
any right or provision in this Agreement shall not constitute a waiver of such right or provision unless acknowledged and agreed to by Invoice
Cloud in writing.All rights and obligations of the parties in Sections 4,6, 10, 12, 14 and 18 shall survive termination of this Agreement. This
Agreement,together with any applicable Biller Order Form,comprises the entire agreement between Biller and Invoice Cloud and supersedes
all prior or contemporaneous negotiations,discussions or agreements,whether written or oral between the parties regarding the subject matter
contained herein.Biller agrees that Invoice Cloud can disclose the fact that Biller is a paying customer and the edition of the Service that Biller
is using.
Additional terms and conditions and definitions applicable to this Agreement and the Biller Order Form are found at
,,v,,vw.invoicecloud.con/termsandeonditions(the"Biller T-C")and are agreed to by Invoice Cloud and the Biller.
Biller Agreement Rev 3.0
The complete Biller Agreement includes the Biller Order Form.the Online Terms and Conditions and this Agreement
P 14
Biller Order Form -,..
Matt Braley sd Cathedral 9 Advanced
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Z EBPP 0 Cloud Store 0 Cloud Pay 0 Pay by Text 0 IVR 0 OBD 0 Kiosk
0 Visa/MasterCard/Discover DAmerican Express 0 ACH/EFT
"J-
Ownership Type: Futility Biller Contacts
Legal Name:
County of Indian River Board of County Commissi Bethany Messersmith
Address 1: 1801 27h Street Phone Number: 772-226-T837 Ext. F
Address 2: Email Address: rbmessersmilh@ircgov com
City: Vero Beach StateF, Zip: 32960 Bethany Messersmith
Phone# (772) 26-1845 Fax#: � F772.770 5318 Phone Number: Ext.
Website URL: I I hU)-://www.ircutlites.com/ I Email Address:
Business Open Date: 1925 FCindy Correnle
Federal Tax ID#: Phone Number: 772.226 1.832 Ext.
i Tax,i–"no,LE;—,c;I N*Orr!LIS-;'--r-Q-tCP C'n0'<o Urlle'-s- Email Address: Fccorrente@ircgov.com
Signatory Contact: IF Bob Solari Title: Board of County Commissioners IF
Phone Number: 772-226-1440 Ext. Email Address: bsolari@ircgov corn
MON,-
- I Re",
New Biller Implementation: $ Paperless Presentment: $ 0-00 Per Item
1 F 0.00 (includes 3 email notifications
Biller Portal Access: F-000 Monthly IC Payment-Credit Card: $ —n/a Per Item
Additional User(s): [ 0—00 Monthly Per User IC Payment-EFT/ACH: $ F—n/a Per Item
Online Bank Direct Access: —0 Online Bank Direct: Per Item
.00 Monthly n/a
Invoice Presentment: 000 Monthly EFT/ACH Reject: 10.00 Per Item
Encrypted Reader License F-0.00 Monthly Charge Back: 100-0 Per Item
Fee:
-MOTA=- 1114'q10MWffr9MD CUM d1'NJ@=CR2D=
Name of Checking Account(As it appears on check or Bank Letter: I Indian River County Board of County Commissioners Utili
Bank Wells Fargo Address: F800 N M agnolia Ave 7th fl 32803 Phone: 407-9-24-2019
Name:
Depository Routing#: Account#-
Yourinvoice payment collections will be electronically deposited into this account.
Fees Routing#: Account#: 1
Invoice and payment processinQ[ees will be electronicall de lucled from this account.
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Onva
eC ouc Y filler Order Form
CERTIFICATION AND AGREEMENT
A. By signing below, the Biller hereby authorizes Invoice Cloud, Inc. ("Invoice Cloud") to initiate and execute debit/credit entries to its
checking/deposit accounts) indicated above at the depository financial institution(s) named above and to debit/credit the some such
account(s) The Biller acknowledges that the origination of ACH transactions to its account(s) must comply with the provisions of U.S law
This authority is to remain in full force and effect until(i)Invoice Cloud has received written notification (by electronic or U.S.mail)from the
Biller of its revocation in such time and manner as to allow Invoice Cloud a reasonable opportunity to act on it,but not less than 10 business
days notice; and (ii) all obligations of the Biller to Invoice Cloud that have arisen under this Agreement and all other agreements have
been paid in full.The Biller must also notify Invoice Cloud,in writing, (by electronic or U.S.mail) when a change in account number(s) or
bank has occurred at which time this authorization shall apply to such new/changed account This notification must be received within
10 business days of change.A fee will be charged for any returned ACH debits.
B. By signing below,the Biller named (1)has read,agreed to,and acknowledges receipt of the Biller Agreement,Biller T+C and other Order
Forms executed by the Biller, and (2) certifies to Invoice Cloud that he/she is authorized to sign this Order Form; (3) certifies that all
information and documents submitted in connection with this Order Form are true and complete; (4)authorizes Invoice Cloud or its agent
to verify any of the information given, including credit references, and to obtain credit reports (including a spouse if in a community
property state), (4)agrees to pay the Monthly Access Fee through the last day of the month following the effective date of termination
as provided in the Billing Agreement: (5)agrees that Biller and each transaction submitted will be bound by the Order Form and the Biller
Agreement in its entirety; (6)agrees that Biller will submit transactions only in accordance with the information in this Order Form and Biller
Agreement and will immediately inform Invoice Cloud, by email (contracts@invoicecloud.com) if any information in this Order Form
changes, and (7) the Biller agrees and understands that outstanding sums due and owing to Invoice Cloud., will be charged daily or
monthly and debited from its current depository account Non-sufficient funds for these debits are grounds for a change in fees or
termination of this Agreement In the event of non-payment of any sums due,Invoice Cloud reserves the right to withdraw such sums from
the current depository account at any time to ensure payment of the same
C. Pay by Text,Standard data rates and text messaging rates may apply based on the payer's plan with their mobile phone carrier Payer
can opt out of text messaging at any time with Invoice Cloud.Partial payment or overpayment is not supported.Service fees may apply
based on the biller set up with Invoice Cloud Biller may not use the service for activities that violate any law, statute, ordinance or
regulation.
D. By signing below,the Biller hereby gives permission to Invoice Cloud to access his/her credit history via Trans Union,Equifax,or other credit-
reporting agency
E. The Order Form and the Biller Agreement will become effective only when counter-signed by Invoice Cloud and upon execution by the
Biller of such third party agreement required by Invoice Cloud to permit use of the payment function of the Service
In WITNESS WHEREOF,the parties hereto have executed this Agreement as of this dayJuly 12, 2016
Accepted by biller: Accepted by Invoice Cloud:
Corporate Officer /
Bob Solari Robert Lapides
Printed Name Printed Name
Chairman, Indian River County President, GUB Division
board of County Commissioners
Title Attest:Jeffrey R.Smith,Clerk of Title
Circuit Court and Comptroller .4.SNP CObi�yl o�
pp A. .........
Deputy Clerk
% t
y
a•�99 ... •oe\o�
a COUNTI.�'rr
APPROVED AS TO FORM •-•-•...e»-'
AND LEGAL SUFFICIENCY
my
- LAN REINGOLD
QQWNTY ATTORNEY
I
OnvoiceCioud' Biller Order Form ,,,,,
ilnvoice i'Patc-n-ole-lei--
Utility 7/5/2016
Invoicing Parameters sheet must be completed for each invoice type.
Advanced Non-Submitter (Chase)
TP
I -�' ' Wl-11
NVisa 0 MasterCard 0 Discover DAnnex NEFT/ACH
MEBPP OCloud Store 0 Cloud Pay 0 OBD 0 IVR DKiosk
S'
Billing Frequency: Monthly Number of Bills: 50,000
Number of Cycles: Weekly Number of Installments: N/A
1
Average Invoice Amount: I F$58 Highest Invoice Amount: $ $125,000
Billing Months(please select the applicable months below):
0-lan OFeb OMar DApr DMay DJun El Jul 0 Aug 0 Sept 00ct 0 Nov 0 Dec 0 All
N 1't- 1 0th [g 11th-201h ED 2111-31 st
0 Biller D Template 0 Bill Print Vendor (.o:ease -,-c mole te be ow)
Cathedral
Lori Forester 4074541633
�o;
Card Readers: [pad QTY 7 Provided by: E:I Sales Rep ®Operations
Per Unit Price: $ 15 Shipping Address:
Monthly (if different than location
Total Due: $ 000 address)
AL;
—r _U T5
8
)D r-"'fna Ruv4v Z'41 LJ OF li
Item Paid by p yer Item Paid by Biller(Non-Submiffer)
• Credit Card: 01 Credit Interchange,fees,dues assessments+
r %with$F Minimum Card: Authorization $ [- + I - %BP
IF—
• EFT/ACH: $ per item F-I EFT/ACH: s Per item
F
• Flex Pay ACH: $ per item ID Flex Pay ACH: per item
Item Paid by payer Item Paid by Biller
• Credit Card: %with$f Minimum 1Z Credit Interchange,fees,dues assessments+
Card: Authorization $ 5-26 + F—642 %BP
• EFT/ACH: Per item 0 EFT/ACH.=$ F035 Per Item
K
❑ Credit Card Service Fee: $ Max Cap for Credit Cards: $
❑ EFT/ACH: Service Fee: $ ID Paid by payer El Paid by Biller
o Paid by payer Service Fee +$ 0 Paid by Biller 1 $1 666 per item surcharge
51
IVR provided through existing provider, Invoice Cloud just acting as merchant processor
CHASE C® Merchant services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www chasepaymentech.com.
Paymentech Phone.(603)896-6000•Fax:(603)896-8715.Merchant_Services@ChasePaymentech.com
•Y Addendum for Application for Credit Card Processing Service
Agreement/New Division Request
Date 7/5/16 Company [D#-
Projected Live Date 10/5/16
SECTION 1: COMPANY/CONTACT INFORMATION
Company Legal Name Invoice Cloud, Inc
Company Taxpayer ID#-
Contact Name Robert Lapides Phone#- (781) 848-3733 EXT 223
Fax#- 877-256-8330 Email Address blapides@invoicecloud com
Transactions processed for this new set up request belong to:
Merchant whose company legal name is represented above
OR
County of Indian River Board of
An Additional Company whose legal name is* County Commissioners and is a ❑ wholly-owned
❑ partially owned ® affiliate ❑ registered DBA or ❑ Other (explain. ) of the merchant noted above
On behalf of Invoice Cloud Inc
(Company Legal Name)
I, Robert Lapides President, GUB Division
(Print Name) (Title)
verify that the account set-up information is accurate, that I have the authority to make such a request and
thus, it should be used to set up an additional account for our company
SECTION 2: BUSINESS-UNIT-:(if different from division name)
Parent Business Unit (up to 30 bytes) Parent Bus Unit#
Name (if applicable) (if applicable)
Business Unit Name: County of Indian River BCC (up to 30 bytes) Business Unit#:
SECTION 3: FUNDING.(if_new banking see section 9)
If funds should be deposited to an existing bank account please complete the following:
If USD or CAD,will funds be deposited into your existing Bank Account set up with Chase Paymentech? ❑Yes or ❑No
If yes, Bank Account# (Section 9 does not need to be completed)
If funds should be deposited to an existing funds transfer instruction please complete the following:
If USD or CAD, will this division utilize an existing Funds Transfer Instruction (FTI)?❑Yes or ONO If no,a new FTI will be created-
If yes, provide FTI # (Section 9 does not need to be completed)
Rev11/18/10 1 NewDivisionSetup/cboo
CHASED Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 .www.chasepaymentech.com
Paymentech Phone (603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com
SECTION 4: 1099K CONTACT INFORMATION (W-9 required ifnewUSentity and/or taxpayer ID, W-8 required for Canadian
entities
Transaction Division's Taxpayer ID#/No Same as Corporate Yes ❑ No
1099K Contact Name Cindy Corrente 1099K Contact email address ccorrente@ircgov com
This is the contact that will receive the 1099K mailing to the address listed on the W-9 supplied(only required if different than Corporate)
SECTION 4a: TRANSACTION DIVISION
Division Name Indian River BCC-Utility (up to 30 bytes-this will appear on your Financial Reports)
Currency(list only 1 each per division) Presentment: US Settlement: US
If using our Cross Currency Product —please provide both the Presentment and the Settlement Currencies
• The following field appears on the customer's statement and identifies the merchant name for the consumer and credit card organizations.To further
aid consumer recognition,Visa has sanctioned the abbreviation of the merchant name. It must be separated from product information by an asterisk
('),which must appear in the 4th,8th or 13th position. The asterisk cannot be used for Retail Merchants. Internet service providers,e-commerce
merchants may utilize a URL instead of Customer Service Phone if not processing any Mail-order transactions(URL must only be 13 bytes)
Cardholder Descriptor(For all card types with the exception of American Express).
C I n I t I y o I f I I n I d I i I a n R v r B I C I C 1 (22 bytes)
Customer Service Phone#,
7 7 2 - 2 2 6 - 1 8 4 5 (13 bytes)
(Required for Mail Order or Recurring)
City' (Required for Retail) (13 bytes)
URL.(optional,if phone#provided above) (13 bytes)
Division Location Address: 1801 27th Street Country: USA
(Must be a street address,PO Boxes not acceptable)
City: Vero Beach State/Prov: F L Zip Code (US): 3 2 9 6 0
(For Retail-City above must match City Location)
Postal Code (Intl): I I I I I I I I Postal Code(Can): (6 bytes)
(State/Province and Postal/Zip codes must match the address given above)
Product/Service Description(Enterproduct description,i.e.clothing, U tI I I f y
books,membership)
Publication Descriptor(Please provide only if required by your submitter)
Avg. Trans. $Amt: 58 Avg #Trans./Yr- 120000 Projected Refund % 5 BPS
How do you market this product? (Check only those that apply to this division)
❑ Catalog ❑ Direct Mail ® Internet ❑ Space Ad ❑TV ❑ Outbound Telemarketing ❑ Other
How will consumers provide credit card information to you when they order this product? (Select only one)
❑ Retail ❑ Mall/Phone(Marketing Material Required) ® Internet(Please provide your URL) http:// www invoicecloud com/ircgov
If internet is selected and the website is not yet available to consumers please complete a Marketing Material Supplement form which you may obtain
from Merchant Services or your account executive.
If Internet, please advise Select one ® SSL ❑ SET ❑ No encryption method
Will the consumer be able to place their order and provide their credit card info (or electronic check info)
through this website? ® Yes ❑ No
Is the web site secure, i e , will the information that the consumer provides, such as their name and
credit card number be encrypted so that it can't be read or intercepted by other people? ®Yes ❑No
Maximum Sale S125k
Transaction Amount. (Default$25,000 U S dollars or established international currency equivalent per transaction)
Maximum Refund $25k
Transaction Amount: (Default$25,000 U S dollars or established international currency equivalent per transaction)
(Approval will be required for any temporary or permanent increases to this ceiling limit)
Please check the consumer's payment option for this division. (Select only one)
®Single payment❑Installment payments ❑Deferred payments❑Recurring(transactions managed by merchant/submitter)
Revl1/18/10 2 NewDivisionSetup/cboo
CHASE Q V Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com
Paymentech Phone.(603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com
SECTION 4: TRANSACTION DIVISION continued
Please check below if applicable
® Bill Payment(A Bill Payment transaction is a transaction for an ongoing service/billing cycle that is known and agreed upon in
advance by the merchant and cardholder i.e Membership or Insurance, etc.)
Do you stock product? ❑ Yes ® No Do you provide custom orders at time of sale? ❑ Yes ® No
Do you own the product at the time of sale? ® Yes ❑ No
Do you drop ship the product? ❑ Yes ® No If yes, what%
Are you filling your own merchandise orders? ® Yes ❑ No
If no, who is your fulfillment service bureau?
Fulfillment Contact: Phone#
SECTION 5: CHARGEBACK CONTACT: (required) IQA (Manager/supervisor—one who assigns work to MCAs)
(Required for retail and Discover)MRQA (Manager/supervisor—one who assigns work to MRAs)
NOTE. This contact may receive any exception documents that may need to be mailed or faxed, if not participating in Chargeback
Management this will be the default contact for Char eback Mailing (second contact will not be required)
Location ❑ Merchant ® Submitter ❑ Fulfillment(check one) If Submitter/Fulfillment, Name
❑ Mr ® Mrs ❑ Ms First Name Carolyn Last Name Ambrose
Title Administrative Assistant Phone#' 781-848-3733 Ext: 231
Fax#- 877-256-8330 Alternate Fax#'
Email Address Cambrose@invoicecloud corn
Address 30 Braintree Hill Office Park
City- Braintree State/Prov MA Zip/Postal Code 02184 Country- USA
Will this contact require access to Transaction History ❑ Report Center ❑ both ® ?
Account Masking for this contact? ® Yes ❑ NO
Does this contact have a Paymentech Online User ID? ❑Yes ®No If yes, provide User ID-
CHARGEBACK CONTACT: (required) MCA (Merchant ChargebackAnalyst—one who works the chargeback's)
(Required for retail and Discover)MRA ((Merchant Retrieval Analyst—one who works the retrievals
® Same as above (check here if the MCA/MRA Contact is the same as the IQA/MRQA contact)
Location ❑ Merchant ❑ Submitter ❑ Fulfillment(check one) If Submitter/Fulfillment, Name
❑ Mr ❑ Mrs. ❑ Ms First Name Last Name
Title. Phone#- Ext:
Fax#- Alternate Fax#*
Email Address
Address
City- State/Prov Zip/Postal Code Country-
Will this contact require access to Transaction History ❑ Report Center ❑ both ❑ ?
Account Masking for this contact? ❑ Yes ❑ No
Does this contact have a Paymentech Online User ID? ❑Yes ❑No If yes, provide User ID
Rev11/18/10 3 NewDivisionSetup/cboo
CHASE tom® Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 .www.chasepaymentech.com
Phone:(603)896-6000•Fax:(603)896-8715•Merchant,Services@ChasePaymentech.com
Payrra>�zratt�ct� -
SECTION 6: PRODUCTS & SERVICES
Please indicate if you will be using any of the following additional services Please note that some of these services May
require an additional contract addendum and/or information if you currently do not have the service (For information on
these services,please contact your Chase Paymentech Relationship Manager)
1 ❑Authorization Recycling
#of recycle attempts: (Default is 3 if left blank) #of days between attempts: (Default is 3 if left blank)
Output Options: ❑Total(recommended) ❑Standard
2. ❑ MC/IM SecureCode ❑ UKDM SecureCode
3 ❑Account Updater(US Only, Canada & UK Only)
❑Submitting or❑Extracting (if extracting Indicate#of Days: (1-180 days)(if Orbital Gateway
For UK-Account Updater Visa EU Merchant ID required
SECTION 7: METHODS OF PAYMENT
®Visa ® MasterCard ❑ JCB (US& Yen only) ❑ UK Maestro/Switch Solo (UK domicile and GBR currency only)
(As a default Discover will be set up except for those merchants that are retained by Discover,or do not have a company location address in the United
States. As a default Discover Diners added whenever Visa and MC are added.)
❑ Discover Canada (CAD only) ❑ Discover Diners Canada (CAD only)
❑ Private Label vendor
Private Label attributes Please supply attributes for Private Label Vendor
(Please work with your Vendor to obtain these attributes—for example—HRS Household—Please provide Credit Plan#)
❑ Discover(conveyed only)(US only) SE# I I I I I I I I I I I I I 1 1 (15 bytes)
❑American Express(conveyed) SE# (10 bytes)
As a rule.(US SE should begin with"1-8", International SE should begin with a"9", Canadian SE should begin with a"93",International SE valid on some
cross currency divisions dependent on presentment currency)
AMEX Parameter Information
Cardholder Descriptor- (Appears on your American Express cardholder statement)(All other card types use descriptor in Section 4)
(20 bytes)
TAA#1 (22 bytes) TAA#2 (22 bytes)
TAA#3 (22 bytes) TAA#4 (22 bytes)
Do you support American Express Partial Auths?
American Express - Yes❑ No ❑
For American Express Only, if yes—please select the following applicable option
Auth and Balance Return ❑ Partial Auth ❑ Both ❑
How have you been classified as a merchant by American Express?- (please select one)
Aggregator ❑ Petroleum ❑ or Neither ❑
® Electronic Check Processing Parameter (US and Canadian only)
Company Name I n d i a n R i v e I r B I C C (16 bytes)
Item Description U t i I i t y (10 bytes)
Preferred Delivery Method (select only one)
® Best Possible (US only) ❑ Facsimile Draft (US only) ❑ACH/EFT(US&Canada)
Redeposit Parameter? ❑ Yes ® No Indicate#of Days 0 The default is"1"
How do you obtain authorization from consumers? (Select only one) ❑ Written consent ❑ Telephone ® Internet
ECP Maximum Sale (If blank,these amounts will default to match the Bank Card Transaction Amounts. Enter an amount
Transaction Amount: here only if the Maximum Sale and Refund amounts for ECP should be different than Bank Card)
ECP Maximum Refund (If blank,these amounts will default to match the Bank Card Transaction Amounts. Enter an amount
Transaction Amount: here only if the Maximum Sale and Refund amounts for ECP should be different than Bank Card)
(Approval will be required for any temporary or permanent increases to this ceiling limit)
Rev11/18/10 4 NewDivisionSetup/cboo
CHASE CP Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com
Payr>I entech Phone (603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com
SECTION 7: METHODS OF PAYMENT continued
❑ PINI@ss Debit (Not applicable for retail merchants)
Please select the network vendors that you have approval from NYCE ❑ STAR ❑ Pulse ❑ Accel ❑
❑ PIN Based Debit (Applicable to retail merchants only)
PIN BASED DEBIT Requires a PIN Pad—please complete section 8, item#4, entitled "Will you be using a
Point-of-Sale terminal (US and Canada only) or Point-of-Sale software?"
If checked above, this division will be setup for the following network vendors with the exception of EBT
(Pulse, NYCE, STAR, Interlink, Maestro, ACCEL, Alaska Options, Jeanie, AFFN, CU24)
EBT required: Yes ❑ or No ❑ ? FCS#required if processing food stamp transactions
❑ Gift Card (U S only)
❑ Bill Me Later®payment option (US only)
❑ European Direct Debit
For EURO Onl :(Valid only for Euro currency divisions)
Descriptor (16 bytes)
Default will be the first 16 characters of your Cardholder Descriptor unless otherwise noted
Please select country(s) in which you will offer Direct Debit:
AT(Austria) ❑ BE(Belgium) ❑ DE(Germany) ❑ NL (Netherlands) ❑ FR(France) ❑
For GBP Only:(Valid only for GBP currency divisions)
Descriptor I I I I I I 1 1 (7 bytes)
Default will be the first 7 characters of your Cardholder Descriptor unless otherwise noted
Country- UK❑
Redeposit Parameter? ❑ No ❑ Yes Indicate#of days The default is I
❑ PayPal (Valid for US currency only)
Payer Email Address
(32 character limit)(must be a unique email address belonging to the merchants business and must be working at the time of account creation.
Note.No two accounts or divisions can share the same Payer email address.)
Customer Service Email Address
(127 character limit)
Primary Contact Name Phone Email
Descriptor P I A I Y I P I A I L (18 bytes)
Business Name Customer Service Phone# (Optional)
(75 character limit and must not contain the following characters R,<,and>)
Sales Venue- ❑ eBay ❑ Other Marketplace ❑ My own Website(include http) ❑ Other
Avg Transaction Price. $ Avg TransNr Percent of Annual revenue from online sales %
Authentication Method the method by which you(the merchant)will authenticate your customer with PayPal—you must choose only one
PayPal Direct❑ Cardinal Commerce Centinel ❑ (if Cardinal Commerce is involved,please complete the following)
Are you using Ecometry or CommercialWare Software to facilitate your Paypal Integration? Yes ❑ No❑
Time Zone(based on merchant's location) SSL Security' (check one) HTTP ❑ or HTTPS ❑
Tech Contact Name Phone Email Address
Rev11/18/10 5 NewDivisionSetup/cboo
CHASE CV-;
Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com
Paymentech
Phone:(603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com
SECTION 8:"PROCESSING METHOD -
Who will be submitting transactions to Chase Paymentech?
® Merchant ❑ Other Co Name Invoice Cloud (i.e.fulfillment co. or ECommerce provider)
If known, please provide the Presenter ID#(PID) or Submitter#(SU)
❑ 1.Will you be submitting transactions from a computer system?
What is the name of the manufacturer and model of your computer platform?
What is the name of the manufacturer and model of your modem? ❑ Internal ❑ External
Will you be coding to Chase Paymentech specifications? ❑ Yes ® No
Will you use NetConnect Batch for Connectivity? ❑ Yes ® No
Will you use NetConnect for connectivity for online authorization only? ❑ Yes ® No
If yes, NetConnect Contact Name Email
Userld (if existing) Phone
If applicable, name the software vendor and application you will be using to format your files
® 2.Will you be using the Orbital Payment Gateway? *If this is the first division using the Orbital Payment Gateway,please contact
your Relationship Manager
Primary Contact` Tony Cordova UserlD (if existing)
Address 642 E Washington St.
City- Brownsville State TX Zip/Postal Code 78520 Country- USA
Phone 956-542-6825 Email (required) tcordova@invoicecloud.com
*Primary contact must be the merchant contact for security needs.
Auto-Settle Time none ❑AM or El PM To meet 10 ET Host window,this should be set no later than Bpm
to allow Gateway to settle.
Merchant Time Zone NA Note.The Auto-Settle time is based in the merchant time zone (US time zones only)
Profile Management required? ❑Yes or®No Level of access ❑ Merchant or❑ Chain (select one,default is Merchant)
VT Import Functionality? ❑Yes ® No
Auth Recycling? ❑Yes ® No #of Recycle Attempts (Default is 3) #of Days between attempts
❑ 3.Will you be using: ❑ Paypal/Verisign ❑ CyberSource
❑4.Will you be using the iTerminal? (retail divisions only)
Primary Contact* UserlD (if existing)
Address
City State Zip/Postal Code Country-
Phone
ountryPhone Email (required)
*Primary contact must be the merchant contact for security needs.
Auto-Settle Time ❑AM or❑ PM To meet 10 ET Host window, this should be set no later than 8pm to allow Gateway to
settle.
Merchant Time Zone Note The Auto-Settle time is based in the merchant time zone.(US time zones only)
Magtek Reader Needed? ❑Yes❑No If Debit, PinPad Needed? ❑Yes ❑No If Yes, NBS7100❑ or Verifone SC50000
(If Yes,Magtek Readers are purchase only) (iTerminal is only certified to utilize the above PinPads and are purchase only)
6
Rev11/18/10 New Division/cboo
CHASEMerchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com.
PaymeIntech Phone.(603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com
SECTION 8: PROCESSING METHOD continued
❑5. Will you be using a Point-of-sale terminal (US & Canada only) or Point-of-Sale software?
Point of Sales Software:
POS/Software Name Host Capture ❑ Terminal Capture ❑
Connectivity- Dial ❑ NetConnect❑ (If NetConnect see requirements below)
If NetConnect: Where is your software hosted/configured? Corporate location❑ or Division location❑
NetConnect Contact Name Email address
Userld if existing Phone
PIN Pad Type and quantity?(for PIN BASE DEBIT Only) Quantity-
Is PIN Pad Existing ❑ or PIN Pad Purchase Needed❑
Injection—Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key?❑
Who will be injecting the Encryption Key into your PIN Pad? Please select one below
❑ Chase Paymentech Solutions ❑ Other Vendor Name
Equipment/Terminals.
Will you ❑ Purchase? ❑ Rent? (US Only) If purchase or rent, date needed by,
❑ Use existing equipment? ❑Yes ❑ No Terminal quantity? Printer quantity?
Terminal/Equipment Type Printer Type
Host Capture ❑ Terminal Capture ❑
Connectivity, Dial ❑ NetConnect ❑ Wireless ❑ (If NetConnect see requirement below)
NetConnect Contact Name Email address
Userld if existing Phone
PIN Pad Type and quantity? (for PIN BASE DEBIT Only) Quantity,
Is PIN Pad Existing ❑ or PIN Pad Purchase Needed❑
Injection—Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key? ❑
Who will be injecting the Encryption Key into your PIN Pad? Please select one below-
❑ Chase Paymentech Solutions ❑ Other Vendor Name
Store Phone#, Terminal Line Phone#, Dial Out Prefix (9,8,5).
Customer Service Phone# (if different then Store Phone#)
Equipment/Kits/Imprinters Ship To Address(if different than store Attention to
location)Please ensure a contact will be available to accept shipment:
Default will be Store Manager
Street Address
City- State/Prov Zip/Postal Code Country,
Ship to contact's phone#- Ship to contact's email
Store Opening Date Special Requirements
Do you require a "re-program" kit? (overlay, quick reference guide, etc) Yes❑ No❑
Do you require an Imprinter? ❑Yes ❑No Type of Imprinter required: With Dater❑ or Without Dater❑
Do you require an Imprinter Plate? ❑Yes ❑No
Do you require a Welcome Kit? (this includes sales drafts, credit drafts, etc) Yes❑ No❑
7
Rev11/18/10 New Division/cboo
CHASE 0-;
® Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com
a" ec Phone-(603)896-6000•Fax:(603)896-8715• Merchant_Services@ChasePaymentech.com
Note: When setting up multiple bank accounts,please complete a separate form for each.
SECTION 9: BANK ACCOUNT INFORMATION
Check only one Settlement Currency in which we Deposit Complete all sections
of the 7 options will fund to you (Country where your Bank Acct listed:
below Resides
Option#10 USD USA A, E
See section A Note section)
Option#2❑ CAD CAN B1 to B3, E
Option#3❑ USD CAN B1 to B3, D3, D4, E
Option#4❑ USD Int'I C1 to C3, D1, D3, D4, E
(list country funds are being deposited in)
Option#5❑ ❑Euro, ❑GBP, ❑JPY, ❑AUD, ❑ Euro Bank or SAME as C1 and/or C2, C3, E
HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK, presentment/settlement currency
❑NZD, ❑ZAR
Option#6❑ ❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑ If DIFFERENT than Settlement C1 and/or C2, C3, D1
HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK, Currency and/or D2, D4, E
❑NZD, ❑ZAR, ❑USD Int'I
list country funds are being deposited in)
Option#7❑ ❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑ CAN B1 to B3, D1, D4, E
HKD, ❑DKK, ❑CHF, ❑NOK, ❑SEK,
❑NZD, ❑ZAR
Section A: US BANK ACCOUNT INFORMATION
(select only one method of transfer)
®ACH Transfer 1 2 1 0 0 0 2 4 8 (ABA#)
❑Wire Transfer (See Note) (Fedwire#/Routing#)
❑Swift Transfer (See Note) (Swift Code (8 to 11 bytes)
Please Note. Swift code is required if your division is located outside of the US or Canada and is settling funds in USD
Wire transfer requires both ACH ABA#and Fedwire#/Routin #
Special Wire Instructions. 60 bytes)
Indian River County Board
Bank Account#' Company Name (As appears on Bank Account) of County Commissioners
Financial Institution Name.
City- Orlando State. FL Zip/Postal Code 32803 Country- United States
®Checking OR ❑ Savings
Section B: CANADIAN BANK ACCOUNT INFORMATION: Transfer Method EFT Only
131 Institution Number EFT Branch Transit Number
B2 Swift Code (8 to 11 bytes) (required if settlement is USD)
B3 Bank Account# Company Name (As appears on Bank Account)
Financial Institution Name
City- Province Postal Code Country- Canada
❑Checking OR ❑ Savings
8
Rev11/18/10 New Division/cboo
J
CHASE .,
'a Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com•
Paymentech Phone (603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com
Section C: FINAL DESTINATION BANK
Account Where Your Funds are De osited
C1 Swift Code. (8 to 11 bytes)
C2 Sort Code (Required in Great Britain Only)
C3 IBAN/Bank Account#
Company Name. (As appears on Bank account)
Financial Institution Name.
City- State/Province Postal Code Country-
Special Wire Instructions. (60 bytes)
�Section.D: INTERMEDIARY/CLEARING BANK ACCOUNT INFORMATION
Note:-For Intl Deposits going through J.P.Morgan Chase in London, termediary is not re uired. Complete Section"C"only
D1 Swift Code. (8 to 11 bytes)
D2 Sort Code (Required in Great Britain Only)
D3 Wire Transfer (USA Only) I (Routing#)
D4 Financial Institution Name
City, State/Province Postal Code/Zip Country-
Special Wire Instructions. (60 bytes)
Section E: Signature
"On behalf of County of Indian River Board of County I, Bob Solari represent and warrant
Commissioners
(Merchant Legal Name) (Print Name)
that I have the authority to add banking information and I verify that the above banking information is accurate and should be used to
transfer funds accordingly"
qlf Q=/ .� Board of County
Commissioners
Authorized Signature* Title 15ate
(*Must be signed by Executive or Financial Contact)
Note: In order to process this request, please attach an original voided check (starter check or bank
statements not applicable) or a bank letter of verification.
ATTACH VOIDED CHECK HERE
-------------- ----------------APPRIWEDA-S- OFORIVI
Attest:Jeffrey R. Smith, Clerk of AND LEGAL SUFFICIEN
Circuit Court and Comptroller •p..Ay�•• � I
�•4 JNSY COittM�ss/os Y DYLAN RrINGOLD
er *; •.y�; OOUNt`I''ATTORNEY
s
Deputy erlF •v':
y`2F QN.
Rev11l18/10 1NTf. �' New Division/cboo
•.•O.•�
CHASE 'Qr Merchant Services•4 Northeastern Boulevard,Salem,NH 03079-1952 •www.chasepaymentech.com
Paymentech
Phone (603)896-6000•Fax:(603)896-8715•Merchant_Services@ChasePaymentech.com
SECTION 10: REPORT.CENTER AND TRANSACTION HISTORY ACCESS FORM
1. Please be sure to include the information below for additional contact that requires access to Transaction
History and/or Paymentech Online Report Center.
2. Report delivery will be web based via Paymentech Online
3. Please note You, the merchant, are responsible for advising Chase Paymentech of changes in Paymentech
Online contacts Chase Paymentech assumes no responsibility or liability of any kind for Merchant's failure to
advise Chase Paymentech of changes to or elimination of Paymentech Online Users
Please be sure to complete all fields below
Salutation. Check one ® Mr ❑ Ms ❑ Mrs
Name Robert Lapides Title President, GUB Division
Phone#, 781-848-3733 Fax#, 877-256-8330
Address 30 Braintree Hill Office Park, Suite 303
City- Braintree State/Prov MA Zip/Postal Code 02184 Country- USA
Email Address (40 bytes) blapides@invoicecloud com
(username@domain.com)
Does this contact have a Paymentech Online User ID? ❑ Yes ® No If yes, please provide User ID,
Does this User require access to ❑ Reporting ❑ Transaction History ® Both Account Masking ® Yes❑ No
For existing merchants— Is this User replacing an individual with Paymentech Online Access? ❑ Yes ❑ No
If yes,who? Has this individual left the company? ❑ Yes ❑ No
For existing merchants—Is this User's access to be mirrored like another User Paymentech Online Access?
❑Yes ❑ No
If yes, who?
Salutation. Check one ❑ Mr ® Ms ❑ Mrs
Name Deborah Bowler Title VP of Operations
Phone#, 781-848-3733 Fax#. 877-256-8330
Address 30 Braintree Hill Office Park, Suite 303
City. Braintree State/Prov MA Zip/Postal Code 02184 Country- USA
Email Address (40 bytes) dbowler@invoicecloud com
(username@domain com)
Does this contact have a Paymentech Online User ID? ❑ Yes ❑ No If yes, please provide User ID
Does this User require access to ❑ Reporting ❑ Transaction History ® Both Account Masking ® Yes ❑ No
For existing merchants— Is this User replacing an individual with Paymentech Online Access? ❑Yes ❑ No
If yes,who? Has this individual left the company? ❑ Yes ❑ No
For existing merchants—Is this User's access to be mirrored like another User Paymentech Online Access?
❑Yes ❑ No
If yes, who?
For additional Users;:please submit additional forms.
President, Government, Utilities
I, Robert Lapides and Business Services Division verify that the
(Print Name) (Title)'
contact information is accurate, that I have the authority to make such a request and thus it should be used to grant
access for these contacts to access Transaction History and/or the Report tenter
,(� g t
Signature: 'rC cid{j i.
*(must be signed by Executive or Financial Contact)
10
Rev11/18/10 New Division/cboo
i
CHASE Cp GovernmentOwned Addendum
Pa ntec�'ll (PA nicigal Utilities,lVilunicipalities,Gov't Agencies)
Rev GOV 11/2015
This Addendum supplements the Merchant Application And/or Agreement executed and submitted by
County of Indian River Board of Court (Merchant Legal Name - "Merchant"). As such, this Addendum shall (i)
be deemed incorporated into and a part of Merchants Application to establish a Merchant account with
Paymentech, LLC and JPMorgan Chase Bank, N.A. and (ii) in accordance with such Merchant Application
and Agreement, constitute a part of the entire Agreement governing all Merchant accounts.
�.�t �'4a �-� � ;iA 'f-' • `i; ,.$ a-l` *�'�_ +`f.. '2;:etc'' x ;£. f.
Merchant is a Government Entity Function of Merchant.
Utility
Authorized Purpose of Government Entity?
Utility
I, the undersigned, certify By submitting this Addendum, Merchant, through the
•that I am an officer or other authorized representative of undersigned Authorized Representative
the Merchant ("Authorized Representative") and • represents and warrants that the person submitting this
•that I am duly authorized to enter into agreements on Addendum is duly authorized to enter into agreements
behalf of Merchant and to legally bind Merchant to such on behalf of Merchant and to legally bind Merchant to
agreements such agreements
•that I am duly authorized to submit this Addendum and • represents and warrants that all information contained
all information contained herein on behalf of the within this Addendum is true, complete and not
Merchant. misleading
Authorized Representative
x U049410121�� t Bob Solari July 12, 2016
Signature Print Name Date
p.jjAttest: Jeffrey R. Smith, Clerk of APPROVED AS TO FORM
yj••. Circuit Court and Comptroller
ssio. AND LEGAL SUFFICIENCY
%
Deputy Clerk -PLAN REINGOLD
• = COUNTY ATTORNEY
•••'9�E..COU.... O r
Page 1 of 1
I
Pricing Schedule to Agreement Merchant Name: Invoice Cloud, Inc.
Electronic Check (eCheck)
For Transactions for: County of Indian River-Board of County Commissioners
CHASESTM rrci� Schedule Agreement
Paymentech Electronic check (eCheck)
k"A' —,2,4gre"Ps'��'^5..: .r,.-,`BFi;;�.•F^'u'-..�,..;.:.�;��..,;-:.. �s��ti�"„.•L.�nq,., .t=,x..'�_-'• :,,;1:'�'
a •s. _e .a" .� u -a
Annual eCheck Transactions 86,400 Avg eCheck Transaction Amount $5800
"'.F tm'h','-`�v .., ?r:. a�.,''arrs ."..,-,a:
;:rlra��, '`g,., 12 ,.,, F�_
a 4'''_}'• 'y`..r.v - -rs �'&:; .: „ti."• fib. ---;:r. :x
:zb�MW - ",�..: -�.
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04.10,
eCheck Validation (Online or Batch Validate Only) - This fee is assessed when using a
'Validate Only' action code and when the transaction passes Validation Validation occurs on every See Volume Schedule
ECP transaction submitted The validation process includes format and data edit checks, bank routing
number checks and comparison to Paymentech proprietary internal negative file
eCheck ACH Transaction — This fee is assessed for successfully deposited eCheck transactions See Volume Schedule
indicating the bank account has been successfully debited or credited
eCheck Prenote Transaction —This fee is assessed when a prenote transaction is run which is a See Volume Schedule
zero dollar transaction that determines whether the account number information is valid
eCheck Redeposit Transaction — This fee is assessed when an ACH return occurs and the
merchant has authorized Paymentech to resubmit the item to the ACH network. Only transactions $ 035
returned for insufficient or uncollected funds can be resubmitted
eCheck ECP Deposit Check (Facsimile Draft) Deposit - Paper(Facsimile) Drafts are created
when a transaction is not eligible for ACH processing The transaction is sent to the bank outside of $500
the ACH network.
eCheck Redeposit Paper Draft - This fee is assessed when a paper return occurs and the
merchant has authorized Paymentech to resubmit the item through the banking system (e g NSF $ 04
Returns/Uncollected Funds)
syr,rte. :5 iG" a;• _-:,isY...:�;=, `- ' :. <.f� t. -�""=Y^ ..7�u,� �=��.;$. ..�>.-
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&9 O O -0 - -' .k¢'�`+�*�'.''_- _ � .v."$ ' .5
j.^fiPx,E, - 4, �K%:itiz{'y^�-�:ti?t`',4<`,.�:;.'. /`y;<'"J,.',�, .�y„ ^y}�
3Y 7 Y i '.f"'+vt �-„:r...fe.-- t4'�`nx'Da S: �3- �3"a-' �s:'s'd..:.A'<-
ACH Return/ACH Dishonored Return Processed/Represented - This fee is assessed every
time an item which has been presented for deposit into the ACH network is returned by the RDFI $ 25
(consumer bank)or when Paymentech dishonors a late return originally initiated from the RDFI
eCheck Notification of Change — This fee is assessed when Paymentech receives a change
notice from RDFIs (consumer's bank) on bank format changes (Routing/Account Number) This $ 07
information is conveyed back to our clients as a NOC when an old or previous Routing/Account
Number is used This is particularly important for clients who store consumer profiles
Deposit Matching - This fee is assessed whenever a transaction that is submitted with old
routing/bank account information is updated by our NOC system with the corrected bank information $ 75
The system updates are based on Notification of Changes that have been stored in our NOC
database.
Facsimile Draft Return/Dishonored Paper Return Processed/Represented - This fee is
assessed for those items which have been presented to the RDFI as Paper Drafts but have been $ 10
returned or when Paymentech dishonors a late return
� :';`;� -
„ �. ��».f`
a�:� -... i,..'' ,.a� .+..c.a ax�w e,s, r.. O.sx,oz���i:sr -^.�;:awv.,�-'•e.`.._':` ,a:3v' '.c:�7�``�,�:s:`-`:< :s^,.a,',,:•���''a +�.',„#e�.
eCheck Reject Fee — Submitted transactions are validated prior to deposit. If the transaction fails $ 04
validation this fee is charged instead of the eCheck ACH Transaction fee
Internal Paymentech Use Only: Rev 08/15
Paymentech Contract No 063576 Page 1 of 2 Date July 6,2016
Pricing Schedule to Agreement Merchant Name: Invoice Cloud, Inc.
Electronic Check (eCheck)
For Transactions for: County of Indian River-Board of County Commissioners
eCheck Annual Volume Schedule
s.,Kr_-"
rz
`u« ..,rF r :+��=='q'. .• xr �r� �'-,•i,• rts., a�"'" :�'�� 0�•i,;,5�:�. 'ss-': r,'�i 5 x'•.�`'" a�:�- kis
4.
�',.�, m'" e .:yy,.'*�7: ••" ori' ?.„ ac:..3 ?.°r�k ,d fl
�$a�:,a��x;.ii:�*�...• ^'N �"s+=3:`r.`-?,tr=�.`3'�'.a. &:"• � �'3". t� - 'es:;} �� { M1�c� :fin q Q i3, -•�'��N.., w '.m
_ �i�.*,..d, t'"s,'t.x_ :s>�su�`'�k p..f.:'�2%.'`z!'+'-�,_..fr' •.:.I ,h' ,- :"€a.�:" ,�C:4�.�.mr"'z"`w.,'i ¢�%.> r.`'a-�,7P'y �'.+°&:h"<.
Tier 1 First 1,000,000 1 — 1,000,000 $ 0200 $ 040
Tier 2 Next 9,000,000 1,000,001 — 10,000,000 $ 0150 $ 035
Tier 3 Over 10,000,000 10,000,001 + $ 0125 $ 025
The above grid applies to ECP transactions beginning as of the date of the first submission of ECP Transactions to Paymentech and
continues for the term of the Agreement. We agree to rebate fees only in the case where we fail to reduce the transaction fee when
Submitter's volume reaches the next grid level
Internal Pavmentech Use Only: Rev 08/15
Paymentech Contract No 063576 Page 2 of 2 Date July 6, 2016
CHASE 0 3
Paymentech
SUBMITTER r11ERCHANT
PAYMENT PROCESSING INSTRUCTIONS AND GUIDELINES
Paymentech, LLC ("Pa}vnentech" or "we", "us" or "our" and the like), for itself and on behalf of JPMorgan Chase Bank, N A
("Member"), is very excited about the opportunity to Join Invoice Cloud, Inc. in providing you with state-of-the-art payment
processing services. When your Customers pay you through Invoice Cloud, Inc., you may be the recipient of a Card funded payment.
The organizations that operate these Card systems (such as Visa U S A . Inc and MasterCard International Incorporated; collectively,
the "Payment Brands") require that you (i) enter into a direct contractual relationship with an entity that is a member of the Payment
Brand and (ii) agree to comply with Payment Brand Rules as they pertain to applicable Card Transaction you submit through Invoice
Cloud, Inc.. You are also required to fill out an Application with Paymentech The Application provides Paymentech with
information relative to your processing practices and expectations
By executing this document, you are fulfilling the Payment Brand Rule of entering into a direct contractual relationship with a
member,and you are agreeing to comply with Payment Brand Rules as they pertain to Transactions you submit for processing through
the Invoice Cloud, inc service We understand and acknowledge that you have contracted with invoice Cloud; Inc. to obtain Card
processing services on your behalf and that Invoice Cloud; Inc may have agreed to be responsible for your obligations to us for such
Transactions and as set forth in these guidelines.
The following information is designed to inform and assist you as we begin our relationship
1. Your Accen/ance of Cards
• You agree to comply with all Payment Brand Rules, as may be applicable to you and in effect from time to time You understand
that we may be required to modify these instructions and guidelines in order to comply with requirements imposed by the
Payment Brands.
• In offering payment options to your customers; you may elect any one of the following options These acceptance options above
apply only to domestic transactions
(1) Accept all types of Visa and MasterCard cards, including consumer credit and debit/check cards, and commercial credit and
debit/check cards.
(2) Accept on/j,Visa and MasterCard credit cards and commercial cards (If you select this option, you must accept all consumer
credit cards(but not consumer debit/check cards)and all commercial card products; including business debit/check cards); or
(3) Accept on/j; Visa and MasterCard consumer debit/check cards (If you select this option; you must accept all consumer
debit/check card products (but not business debit/check cards)and refuse to accept any kind of credit cards).
• If you choose to limit the types of Visa and MasterCard cards you accept, you must display appropriate signage to indicate
acceptance of the limited acceptance category YOU have selected (that is, accept only debit/check card products or only credit and
commercial products)
• For recurring transactions, you must obtain a written request or similar authentication from your Customer for the goods and/or
services to be charged to the Customers Card; specifying the fi-equency of the recurring charge and the duration of time during
which such charges may be made v
2. Settlement
• Upon our receipt of your Transactions; we will process your Transactions to facilitate the funds transfer between the various
Payment Brands, you and Invoice Cloud, Inc Unless otherwise agreed to by the parties; after we receive credit for such
Transactions, we will provide provisional credit to one or more of the Bank ACCOUnt(S) you designate herein under the "Funding
Schedule"section.
• You must not submit Transactions for payment until the goods are delivered, shipped; or the services are performed. If a
Customer disputes being charged for merchandise or services before receiving them; the result may be a Chargeback to you.
3. CharQebacks
• You may receive a Chargeback for a number of reasons The following are some of the most common reasons for Chargebacks.
but in no way is this meant to be an exhaustive list of all Chargeback reasons
(1) You do not issue a refund to a Customer upon the return or non-delivery of goods or services,
(2) An authorization/approval code was required and not obtained,
INTERNAL PAYMENTECH USE Rev 01/14
Merchant Name County of Indian River-Board of County Commissioners Paee I of 3 Paymentech Contract No 06376
(3) The Transaction was fraudulent;
(4) The Customer disputes the Card sale or the signature on the sale documentation; or claims that the sale is subject to a set-off,
defense or counterclaim, or
(5) The Customer refuses to make payment for a Card sale because in the Customer's good faith opinion, a claim or complaint
has not been resolved, or has been resolved by you but in an unsatisfactory manner
4. Data Secarih?and Privacy
• By signing below, you represent to us that you do not have access to any Card information (such as the Customer's primary
account number, expiration date, security code or personal identification number) and you will not request access to such Card
Information from Invoice Cloud, inc In the event that you do happen to receive Card Information in connection with the
processing services provided by Invoice Cloud, Inc or Paymentech under these guidelines, you agree that you will not use it for
any fraudulent purpose or in violation of any Payment Brands or applicable law and you will comply with all applicable Payment
Brand Rules and Security Standards. If at any time you believe that Card Information has been compromised, you must notify us
promptly and assist in providing notification to the proper parties. You must ensure your compliance with all Security Standards
that are applicable to you and which may be published from time to time by the Payment Brands. If any Payment Brand requires
an audit of you due to a data security compromise event or suspected event, you agree to cooperate with such audit. You may not
use any Card Information other than for the sole purpose of completing the Transaction authorized by the Customer for which the
information was provided to you, or as specifically allowed by Payment Brand Rules, or required by law in the event of your
failure, including bankruptcy, insolvency or other suspension of business operations; you shall not sell, transfer or disclose any
materials that contain Transaction information or Card Information to third parties.
5. Funding Schedule
• In order to receive funds from Paymentech, you must maintain one or more bank account(s) at a bank that is a member of the
Automated Clearing House ("ACH") system and the Federal Reserve wire system (the "Bank Account') You must designate at
least one Bank Account for the deposit and settlement of funds and the debit of any fees and costs associated with Paymentech's
processing of the Transactions (all such designated Bank Accounts shall be collectively referred to herein as the "Settlement
Account') You authorize Paymentech to initiate electronic credit and debit entries and adjustments to your Settlement Account
in accordance with this Section 5 We will not be liable for any delays in receipt of funds or errors in Settlement Account entries
caused by third parties, including but not limited to delays or errors by the Payment Brands or your bank.
• Unless otherwise agreed to by the parties, the proceeds payable to the Settlement Account shall be equal to the amounts received
by us in respect of your Card transactions less all Chargebacks, Customer refunds and other applicable charges. Such amounts
will be paid into the Settlement Account promptly following our receipt of the funds. If the proceeds payable to the Settlement
Account do not represent sufficient credits, or the Settlement Account does not have a sufficient balance to pay amounts due from
you under these guidelines, we may pursue one or more of the following options (i) demand and receive immediate payment for
such amounts; (ii) debit a Bank Account for the amount of the negative balance; (iii) withhold settlement payments to the
Settlement Account until all amounts are paid, (iv) delay presentation of refunds until a payment is made to us of a sufficient
amount to cover the negative balance, and(v) pursue any remedies we may have at law or in equity.
• Unless and until we receive written instructions from you to the contrary; all amounts payable by Paymentech to you will be
deposited in the Settlement Account designated and authorized by you as set forth below-
Name of Bank wens Fargo
ABA No . 121000248
Account No .
Account Name• Indian River County Hoard of Comm,Commissioners Utilities Account
Reference-
INTERN L
eference•INTERNAL PAYMENTECH USE Rev 01/14
Merchant Name County of Indian River-Board of County Commissioners Page 2 of 3 Pavmentech Contract No 063576
6. De notions
"Application" is a statement of your financial condition; a description of the characteristics of your business or organization, and
related information you have previously or concurrently submitted to us, including credit and financial information.
"Carle' is an account, or evidence of an account, authorized and established between a Customer and a Payment Brand, or
representatives or members of a Payment Brand that _You accept from Customers as payment for a good or service. Payment
Instruments include, but are not limited to; credit and debit cards, stored value cards; loyalty cards, electronic gift cards, authorized
account or access numbers, paper certificates and credit accounts
"Chargeback" is a reversal of a Transaction you previously presented to Paymentech pursuant to Payment Brand Rules
"Customer" is the person or entity to whom a Card is issued or who is otherwise authorized to use a Payment Instrument.
"Alember" is JPMorgan Chase Bank, N.A or other entity providing sponsorship to Paymentech as required by all applicable Payment
Brand. Your acceptance of Payment Brand products is extended by the Member
"Payment Brand" is any payment method provider whose payment method is accepted by Paymentech for processing, including, but
not limited to, Visa, U S.A., Inc , MasterCard International, Inc , Discover Financial Services; LLC and other credit and debit card
providers, debit network providers, gift card and other stored value and loyalty program providers. Payment Brand also includes the
Payment Card Industry Security Standards Council
"Pr►ymenl Brand Rules"are the bylaws, rules, and regulations, as they exist from time to time, of the Payment Brands.
"Card Information" is information related to a Customer or the Customer's Card, that is obtained by you or Invoice Cloud, Inc. from
the Customer's Card, or from the Customer in connection with his or her use of a Card(for example a security code, a PIN number, or
the customer's zip code when provided as part of an address verification system) Without limiting the foregoing, such information
may include a the Card account number and expiration date, the Customer's name or date of birth, PIN data, security code data(such
as CVV2 and CVC2) and any data read; scanned, imprinted, or otherwise obtained from the Payment instrument, whether printed
thereon, or magnetically; electronically or otherwise stored thereon
'Paymentech", "we", "our", and "►►s" is Paymentech; LLC; a Delaware limited liability company, having its principal office at 14221
Dallas Parkway, Dallas; Texas 75254
"Security Standards" are all rules; regulations, standards or guidelines adopted or required by the Payment Brands or the Payment
Card Industry Security Standards Council relating to privacy, data security and the safeguarding, disclosure and handling of Payment
Instrument Information, including but not limited to the Payment Card Industry Data Security Standards ("PCI DSS"), Visa's
Cardholder Information Security Program ("CiSP"), Discover's Information Security & Compliance Program, American Express's
Data Security Operating Policy, MasterCard's Site Data Protection Program ("SDP"). Visa's Payment Application Best Practices
("PABP"), the Payment Card Industry's Payment Application Data Security Standard ("PA DSS''), MasterCard's POS Terminal
Security program and the Payment Card Industry PIN Entry Device Standard, in each case as they may be amended from tune to
time
"Transaction" is a transaction conducted between a Customer and you utilizing a Card in which consideration is exchanged between
the Customer and you.
Please acknowledge your receipt of these instructions and guidelines and your agreement to comply therewith
Agreed and Accepted by: Agreed and Accepted by:
County of Indian River-Board of County Commissioners PAYMENTECH. LLC for itself and on behalf of
MERCHANT LEGAL NAME(Print or Type) JPMORGAN CHASE BANK. N A
1801 27t1 St.. Vero Beach. FL 32960
Ald r nt or T_'pe) By:
1CW_T Q-4.-
By(authorized signature) Print Name. David Miller
Bob Solari, Chairman
By,Name;Title(Print or Type) Title. Vice President. Credit Operations
July 12, 2016
Date Date.
APPROVED AS TO FORM Attest tCourtandCJeffreY R. th,,,Glerko� i i
ANI_'.1 LEGAL SUFFICIENCY CireuitCourtandCa ��-- Nordin Boulevard. Salem.\H 03079
GOOXNco
AilytsS'
By
DYLAN PEINGOLD Deputy Ile* tam
INTERNAL PAY E Rev 01/14
Merchant Name-County of Indian River-Board of Countv Commissioners Page 3 of 3 0 . %ymentech Contract No 063576
"J COUi11�•
Schedule A to Merchant Agreement Merchant Name: Invoice Cloud, Inc.
For Transactions for: County of Indian River-Board of County Commissioners
�
CHASEp
Paentech Schedule A to Merchant gee ent
'';;g=j "r'3'.` '°' "Yaz`S'. :.a�`,','kr> w.i., :z��.•.'a;';x•l.<'Fq",4r`s$M'* tYa:`,;s "�:• :_ �'<.:.. ;;Kw '.;,7 !'-Ye" '""�•,''''" szn'
�t o ah...�,�,:?,�"'�.:" _ - szw''3,'�?";�.r_-=' ,a3�'�^.Rz° :a :a�-*:•«��;; :�i„u:•.� �>,
t$�2�'aui;� K.:tea - �q, -.,s" <r'` "�. •«:3a ""S^`%"�
.:. R
Annual Payment Transaction Volume 86,400 Average Transaction Amount $5800
vy "M:;' "�'_` .^ -c�zi;'=�',"s:,�;'- .C.:�->.�'J`�a�...:-q. . 'fl Ya.'a`�" "�v'"_kn '���`}�'g"� „� - •� ""%;'w.�` $
'�1 Ae • t -t o' t '3s���<a'.c�.',:g•�' i�=a�".•.<, .E<t��' .�.m �.F :^.r.F+ �•`°i _
0 w+ 0 0 'µ��_�'i=�j,.�,� ..�``�c �:s;.:c.. ry "'a?.wS':�v_,.�.' � ':x,:...s�q,"•`�°"..'a _y�k�`;a+'�r a..,.. ..�.
m _ zax•., r-�. k„'• .•:��a.-i.°";' x.s�:=-ia:. a%P���LwsL✓.: Rr..'4=h`?w`EnS �Oayr`. t• Y���a`.,._'� .�"fif'�...:x�°a
Visa Settled Transactions See Volume Schedule
MasterCard Settled Transactions See Volume Schedule
American Express Conveyed Transactions No Charge
Diners Settled Transactions See Volume Schedule
Discover Settled Transactions See Volume Schedule
JCB Settled Transactions No Charge
Visa Authorizations See Volume Schedule
MasterCard Authorizations See Volume Schedule
American Express Authorizations See Volume Schedule
Diners Authorizations See Volume Schedule
Discover Authorizations See Volume Schedule
JCB Authorizations See Volume Schedule
e } e'0 O '0, 6 �A t ' �e'•�>r ti c F6(: srF ':«a ,: r,;., .y�..`T.y#
y,,y '5'•64:;°kS. -,'.''i-km��°j u�"�r`�CS=�t`..'«f..'k S x�"c-:9 i'� t!�'j. wa„.O.. -F — 0 { .WA,�ig Y . -£— fil.""�9p•YµY�'+��.�«�•"�. ';,;'£$::[.:t,.T.�fg'`"€r?`"},`.ey:r`r K"r'� bi`"P�..%'ti.r:.ka,:,',
.^'..
4;y,�it»E:�•_ row. "S:'3.n .. .::";:ice«'lk:«tr Ti'w z'~ ,«d k`..G'7e iqT
Visa Auth Reversal -Visa authorization reversal misuse prevention I See Volume Schedule
MasterCard Auth Reversal -Visa authorization reversal misuse prevention See Volume Schedule
Audio Response Unit Authorization —Charged when voice auth is handled by automated system $ 50
Voice Authorization - Charged when you call the Voice Auth phone number to authorize a credit $ 90
card
Voice AVS Request- Charged to speak to voice operator for each Voice Address Verification I $ 90
request
Voice Authorization Reversal - Charged for each voice authorization reversal I $ 90
Voice AVS Authorization - Charged per each voice Address Verification Service authorization I $1 75
Voice Operator Assist- Charged for each voice operator assistance $1 75
'v;;C.• '=rir:r7V, ^i�:'•`' 5`�•a.�• -y-'ry^ 3 ao;ur. .y . :o-ygLsy,�„ga _a�.
NOW*' A.;,
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',a, 's t���:>3;'>.,,x'-"�"„.>.a,d-s.,s.•p.>a,....;�. �%'� .&�•z:1�. s:. ..adc:xa�rl;'�t'b ,�� �� ���..
Visa, MasterCard, Diners, Discover or JCB Settled Chargeback Processed or Represented $700
Visa, MasterCard, Diners, Discover or JCB Collection, Pre-Arbitration or Compliance I $1000
Intemal Paymentech Use Only: Rev 07116
Paymentech Contract No 063576 Page 1 of 4 Date July 6, 2016
�
Schedule AboMerchant Agreement Merchant Name: Invoice Cloud, Inc.
�
Schedule /\boMerchant Agreement Merchant Name: Invoice Cloud, Inc.
For Transactions for: County mfIndian River-Board ofCounty Commissioners
Schedule A to Merchant Agreement Merchant Name: Invoice Cloud, Inc.
For Transactions for: County of Indian River-Board of County Commissioners
4t.s. l
•G ^.i:ffi t�4e:.; ° <._ '�.-.GY � e� � _9t�k'i"°�"1 �ni�_�' � .^�^.-': ,._;^-`,: tidy`.'-' :�.'�f.lr:"' f�+ ��
�;_ --:�• ss+J"g%�yQ.M^-'-;. y <.u; ,v r`,�x ,'a%.. �?� f K•;::ry r ri�'.3,:.�.µ„... _. ,,, x I .. : .1._r
,�g '.'r.'.'i:' '�'``r_.-i� .dPei'
,�•'J.�,`'.`:s-.rte;, :;ti”, �.,, ''?.i:...: :ti:^k
Visa Fixed Acquirer Network Fee- Visa Fixed Acquirer Network Fee is a monthly fee assessed by Visa per M
tax ID based on Merchant Category Code (MCC), dollar volume, number of merchant locations, and whether the Pass-Through
physical Visa card is present or not present at the time of the transaction. This fee can vary monthly
Payment Brand Fees
A substantial amount of the fees that we charge for processing Transactions consists of charges that we must pay to the Payment
Brands and card issuing banks (or that are otherwise charged to us by the Payment Brands and card issuing banks) under the
Payment Brand Rules These charges (collectively referred to in this Schedule A as "Payment Brand Fees") include, but are not
limited to, interchange, assessments, file transmission fees, processing fees, network access fees, and cross border fees Whether a
particular Payment Brand Fee applies is based on several factors, like the type of Payment Instrument presented, specific
information contained within the Transaction, how and when the Transaction is processed, and the merchant's domicile and industry
Please note that Paymentech may, from time to time, elect not to charge you for certain existing, new or increased Payment Brand
Fees If we elect not to charge you, we still reserve the right to begin charging you for existing, new or increased Payment Brand
Fees at any time in the future, upon notice to you No such Payment Brand Fees will be imposed retroactively
Additional information about significant Payment Brand Fees (Interchange and Assessments), can be found at:
www.chasepaymentech.com/interchange and assessment understanding.html
*MasterCard assesses the MasterCard Acquiring License Fee annually to each Acquirer based on the total annual volume of
MasterCard-branded sales (excluding Maestro PIN debit volume) of its U S domiciled merchants To fairly distribute the fee across
all Paymentech MasterCard-accepting merchants, a rate of 004%will be applied to all of your MasterCard gross sales transactions
Amount due upon Termination
In addition to the other amounts due under this Agreement (including without limitation, the fees and charges described in this
Schedule A), you may owe an amount in the event you terminate this Agreement. Whether you will owe that amount, and how
much you will owe,will be determined in accordance with the terms of the Agreement, including, without limitation, the"Termination"
section.
Volume Schedule
z"+3
- •-;�lK','„-`.#F.' __ - ,si 'H,t a.fk'�'r;�,,:'.c�-'�� 'u�M - O - t_ ', _ `
k�`• _ :4 - 'Ad r ie:e.k,=�i`T='-•` Tx''gT,` `rr� O _ "0 S-♦ - 4°+ "r - a
_ `'j`z�{f��Y y0 .��k^"'ZEe �;", Oc _ !p_ca}��S '.�tZ ' je-�• _ - - �x - - N "
�. ;5t - ;;e_'y� c'�,-xz•w. 3 erg,-^.~ • _ �2,'.zas,.� �,. • �,
54
Tier 1 First 1,000,000 1 — 1,000,000 $ 03 05% $ 03 $ 10
Tier 2 Next 9,000,000 1,000,001 — 10,000,000 $ 02 03% $ 02 $ 05
Tier 3 Over 200,000 10,000,001 + $ 01 02% $ 01 $ 035
The above grid applies to Bank Card, Discover, and Diners transactions beginning as of the date of the first submission of Bank Card
Transactions to Paymentech and continues for the term of the Agreement. We agree to rebate fees only in the case where we fail to
reduce the transaction fee when Merchant's volume reaches the next grid level
Internal Paymentech Use Only: Rev 07116
Paymentech Contract No 063576 Page 4 of 4 Date July 6, 2016
14221 Dallas Parkway,Dallas,Texas 75254 *4 Northeastern Blvd,Salem,NH 03079-1952
CHASECe"O Paymentech' Sales Phone(603)896-8324 • Sales Fax(603)896-8701
www.chasepaymentech.com
W
-We "NINEIR&I NT
COMPANY LEGAL NAME. County of Indian River-Board of County Commissioners —1 59-6000674
REGISTERED TRADE
NAME yEAR BUSINESS STARTED 1925
PHYSICAL 1
STREET ADDRESS: 1801 h Street
(NO PO BOX OR PAID MAIL BOX) 1
CITY Vero BeachLS TATE Fl. ZIP CODE 32960
11
PRIMARY CONTACT Cindy Corrente E# ][(:7:7:2�)226-1845
�]F
TYPE OF ENTITY
r-JINDIVIDUAL/SOLE PROPRIETOR ❑PARTNERSHIP [:]CORPORATION ®GOVERNMENT
FILLC* *IF LLC,TAXED AS. FlDISREGARDED ENTITY nCORPORATION [—]PARTNERSHIP
TYPE OF OWNERSHIP:
F1 PUBLIC ❑PRIVATE F-1 NON PROFIT ❑SUBSIDIARY OF PUBLIC COMPANY ®OTHER: County Government
STATE OF FORMA DATE OF FORMATION(MM/DD/YY
YY)IF YY) 1/1/1925 11
TRADING SYMBOL FISCAL YEAR END(MM/DD/YYYY)
[❑
HAS MERCHANT EMERGENCE DATE.
SERCI ANT EVER FILED BANKRUPTCY? IF YES,WHAT CHAPTER? FILING DATE:
S
FffY ME �KNO
]YE
_6
WINNER`
W,V,ii,Q11 i Mp*m
SOCIAL SECURITY BIRTHDATE
NAME OR OR
TAX ID NUMBER DATE OF INCORPORATION
STREET ADDRESS IF TELEPHONE NUMBER I
CITY STATE HCODE]F
SIGNATURE
PERCENT OWNERSHIP %
--IF
SOCIAL SECURITY BIRTHDATE
NAME OR OR
TAX ID NUMBER DATE OF INCORPORATION
STREET ADDRESS [TELEPHONE NUMBER 11 1
CITY =1 STATE]F_ ZIP CODE11
SIGNATURE I=PERCENT OWNERSHIP %
DO YOU HAVE ANY ADDITIONAL OWNERS(NOT LISTED ABOVE)THAT HAVE 10%OR GREATER OWNERSHIP,EITHER DIRECTLY OR INDIRECTLY?
F1-YES-OWNER ADDENDUM-REQUIRED
RED-(SALES
LES-REPRESENTATIVE- - WILL-PROVIDE)
VIDE) ❑-------------------------- NO-----------------------------------------------
-- --- --- ---------- ----- --- -- -- -------- --- ------ --- ----
NOTE: IF AN ENTITY/PARENT COMPANY IS LISTED IN SECTION 2 ABOVE THAT HAS 10% OR GREATER OWNERSHIP OF THE APPLICANT, IDENTIFY ANY OWNERS
(INDIVIDUALS AND/OR ENTITIES)OF THE ENTITY/PARENT COMPANY THAT ULTIMATELY HAVE 10%OR GREATER OWNERSHIP IN THE APPLICANT ON THE ADDITIONAL
OWNER/OFFICER ADDENDUM(SALES REPRESENTATIVE WILL PROVIDE)
Rev 11/15
Page 1 of 2 Paymentech Contract No.063576
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COMPANY PRESIDENT: Bob Solari(Board of County Commissioners)
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SIDENTIALADDRESS IS PREFERRED,BUT IF NOT AVAILABLE BUSINESS ADDRESS IS ACCEPTABLE)
REET ADDRESS 1801 27th Street1
CITY 11 Vero Beach STATE FL ZIP CODE 32960
COMPANY CFO: 11
E'REDENL ADDRESS IS PREFERRED,BUT IF NOT AVAILABLE BUSINESS ADDRESS IS ACCEPTABLE)
RESS
CITY =1 STATE Oe ZIP CODE
IS THERE ANYONE NOT LISTED ABOVE WHO HAS THE AUTHORITY TO MAKE FINANCIAL DECISIONS OR CONTROL COMPANY POLICY ON BEHALF OF YOUR BUSINESS?
❑YES OWNER ADDENDUM REQUIRED(SALES REPRESENTATIVE WILL PROVIDE) NNO
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AUTHORIZED ADMINISTRATOR FOR PURPOSES OF ACCOUNT BOARDING AND IMPLEMENTATION MEANS AN OWNER,PARTNER,OFFICER,EMPLOYEE OR OTHER AGENT
OF THE MERCHANT THAT HAS BEEN APPOINTED BY AN EXECUTIVE OF MERCHANT AND WHO IS DULLY AUTHORIZED TO PROVIDE INFORMATION AND EXECUTE
DOCUMENTATION ON BEHALF OF AND RELATED TO MERCHANT IN ORDER TO FACILITATE THE INITIAL SET UP OF MERCHANTS'S ACCOUNT WITH CHASE PAYMENTECH.
PER CHASE PAYMENTECH POLICY,AUTHORIZED ADMINISTRATORS ARE NOT PERMITTED TO MODIFY THE MERCHANT'S ACCOUNT WITH CHASE PAYMENTECH AFTER
COMPLETION OF THE INITIAL SETUP OF MERCHANTS'S ACCOUNT SUCH CHANGES MUST BE MADE,BY AN EXECUTIVE OR FINANCIAL CONTACT,AS APPLICABLE AND AS
THOSE ROLES ARE DEFINED BY MERCHANT
NAME(please print) Bob Solari TITLE(please print) Board of County Commissioners
TELEPHONE NUMBER 772-226-1440 EMAIL ADDRESS. bsolari@ircgov.com
SIGNATURE 01.• DATE: July 12 2016
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I,the undersigned,being an officer/principal of represent and warrant that the statements made on this document are correct and factual. JPMorgan Chase
Bank, N.A ("Member") and Paymentech, LLC ("Paymentech" or "Chase Paymentech") are authorized to conduct any necessary investigation, including without
limitation,authorization for a bank to release standard banking information.
(Photocopy of signature below is valid for the release of information and will remain valid until the termination or expiration of the Merchant Agreement)
NAME(please print) Bob Solari TITLE(please print) Board of County Commissioners
SIGNATURE I DATE July 12, 2016
(IF THE SIGNER HAS NOT ALREADY PROVIDED IT ABOVE,A RESIDENTIAL ADDRESS IS PREFERRED, IF AVAILABLE (NO PO BOX OR PAID MAILBOX). IF NOT AVAILABLE
BUSINESS ADDRESS IS ACCEPTABLE.
STREET ADDRESS 180127th Street
CITY Vero BeachSTATE FL ZIP CODE 32960
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SUBMITTER NAME Invoice Cloud,Inc.
*Note: Each Merchant is required to submit a W9 with this application, regardless if Paymentech will be utilizing the Submitter's TIN for IRS
reporting purposes. .�y�OA1M/s8j•'•
Attest,JetRey R.Smith,Cterk of o•J�`• .�A�F9
t VO• '
Circuit Couft and Comptrdlw
APPROVED AS TO FORM *i
AND LEQAL. SUFFICIENCY or.
BYu Deputy Cleric ••?�'9,y• t; r ;0��:
DYLAN Al2INGOLD �•'R:�'ERCa11NrE''✓
"WNTY AfT6RNEY ".
Rev 11/15
Page 2 of 2 Paymentech Contract No.063576