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Date:MERCHANT APPLICATION AND AGREEMENTSalesperson NumberSigning Rep:BUSINESS NAME (S)Sales Office Phone:Legal Name of Business:BUSINESS PROFILEDBA (doing business as):Internal Use OnlyMerchant Number:Mailing/Billing Address:Send Retrieval Requests to:City, State, ZIP:Send Merchant Monthly Statements to:Business LocationMailing / Billing AddressBusiness LocationMailing / Billing AddressContact:Phone Number:Business StructureFax Number:State FiledIndividual / Sole ProprietorshipPartnershipCorporation (chapter LLC, S or C)OtherMerchant E-Mail AddressLocation Address (if different from mailing)City, State, ZIP:Federal Tax ID (9 digits):Country:Contact Name:USAPhone Number:Business Open Date:Fax Number:SIC / MCC:Internal Use OnlyPrior BankruptciesNoIf yes, whenMERCHANT PROFILE (BUSINESS)Detailed Explanation of Type of Merchandise, Products or Services Sold:Number of Locations:Estimated Average Ticket Combined Est. Monthly Vol for Visa /MasterCard /Discover Network Front End Processor:CTS-MemphisCTS-BuypassCTS-VitalEst. High Ticket Omaha-OmahaOmaha-NashvilleOmaha-NorthMail / Telephone Order Information1-What % of total sales represents business to business vs. business to consumer?Business to Business% Business to Consumervs.2-What % of total sales is SWIPED?%3-If transactions are key entered what percent is:Face to Face4-KEYED ENTERED?Enter URL the transactions are entered into:www.Who performs product / service fulfillment?Merchant / Direct%MO/TO% 100%(total sales)% 100%(total sales)% Internet% 100%Vendor, if vendor addName:Address:City / State / Zip:Phone:Please describe how the transaction take place, from order taking to merchant fulfillment (attach additional sheet if necessary)5-Does any of your cardholder billing involve automatic renewals or recurring !Walnut!Creek,!CAYesNoPage!1!of!25

OWNER / PARTNERS / OFFICERSOWNER / PARTNER / OFFICER 1OWNER / PARTNER / OFFICER 2Name: (First, MI, Last)Name: (First, MI, Last)Title:% OwnershipHome Address:Title:% OwnershipHome Address:(No PO Box)(No PO Box)City:State:Zip:City:State:Telephone #Telephone #Social Security #Social Security #D.O.B.DL #State:D.O.B.DL #Zip:State:SETTLEMENT INFORMATIONA voidedcheck fromthis accountmust beattachedDeposit BankBank PhoneTransit / ABA #Name on DDADeposit Account # DDACREDIT CARD ACCEPTANCE / ENTITLEMENTSCheck those cards you choose to accept (acceptance of all Discover Network, MasterCard and Visa transactions is presumed unless any sections below are checked.X Accept MasterCard Credit Transactions OnlyX Accept MasterCard Signature Debit Transactions OnlyX Accept Visa Credit Transactions OnlyX Accept Visa Signature Debit Transactions OnlyXX Accept Discover Network Non-PIN Debit Transactions OnlyAccept Discover Network Credit Transactions OnlyCurrent American Express MID #If no AMEX MID, do you want to accept AMEX?YesNoFIRST DATA GLOBAL LEASINGLease Company: First Data Global LeasingTotal Monthly Lease Charge: Lease TermMonthsAnnual Tax Handling Fee: 10.20W/o taxes, late fees, or other charges that may apply - See section 30 of your Merchant Agreement for details.The is a non-cancelable lease for the full term indicated. First Data Global Leasing will automatically debit theSettlement Account identified on page 2 for all accounts owing under the lease.(Merchant's Initials:)The equipment/products to be leased are referenced in the Equipment/Software section of this Merchant Application, located on page 3.TELECHECK INFORMATIONECA Check WarrantyOtherCheck WarrantyTeleCheck Monthly Minimum Fees Inquiry RateCharge per Transaction Monthly Processing Fee Setup Fees Warranty Maximum ** Other Flat Fee ECA Funding Report (choose one):Monthly (included at no charge)Weekly 10.00%5.00Daily 15.00Customer Requested Operator Call 2.50December Risk SurchargeECA Chargeback Fee 5.00ECA Connection Fee0.10% 5.00Recovery Processing Fee 5.00Warranty Research Fee 7.50Term and Termination. TeleCheck will provide the TeleCheck Services selected in the TeleCheck Application for an initial term of twelve (12) months from the effective date.Thereafter, the TeleCheck Services shall automatically renew for successive 12-month term until terminated as provided for in the TeleCheck Service Agreement.Damages. Upon your breach or unauthorized termination of the TeleCheck Services, Teletech shall be entitled to recover from you liquidated damages in an amount equal to ninetypercent (90%) of the total aggregate charges payable for the unexpired portion of the then-current term of the TeleCheck Services.Payment. All fees and charges are due upon receipt. You authorize TeleCheck to debit from your financial institution account as provided to TeleCheck by you, all payments andother amounts owed. You agree to pay TeleCheck a 25.00 fee for any check or ACH debit that is not paid by your financial institution upon presentment.** Warranty maximum for ECA is 20,000; Check Warranty is face value of check; Grocery and Convenience Vertical Market program is age!2!of!25

AUTHORIZATION, TRANSACTION AND OTHER FEES(Charged by Processor)Discover Network, MC & Visa Auth Fee / eachSales Trans Fee / eachAmerican Express Auth Fee / eachReturn Trans Fee / eachBatch Fee / each / eachWEX Transaction Fee / eachEBT Trans Fee / eachVoyager Transaction Fee / eachElectronic AVS Fee / eachVoice Authorization Fee / eachChargeback Fee / eachVoice/Audio Response Unit (VRU, ARU) Fee / eachRetrieval Fee / eachOther / eachPIN Debit/ATM Trans Fee(Plus Debit Network Processing Fee)Minimum Monthly Fee / monthlyWireless Fee / eachMonthly Fee / monthlyMonthly Reporting Fee / eachStatement Fee / monthlyDebit Access Fee / eachAnnual Fee / annualOther / each/ one timeEarly Termination Fee A fee charged if this Merchant Agreement is terminated or cancelled prior to the expirationof the initial thirty six (36) month term.MISC MONTHLY FEESFLEET CARD INFORMATIONWright ExpressTransaction Fee3.50%Voyager 0.15Charged by ProcessorOMAHA PLATFORM(Charged by Processor)All fees are subject to change as provided below. For further details, read this entire Merchant Application and Agreement.GRID INFORMATIONMC CreditVisa CreditMPG ID8-position Alpha/NumericMC DebitDiscover NetworkMPG IDCredit MPG ID8-position Alpha/NumericVisa DebitMPG ID8-position Alpha/NumericMC CreditDiscover NetworkMPG IDDebit MPG ID8-position Alpha/NumericVisa CreditTiered Grid ID8-position Alpha/NumericCredit Tiered8-position Alpha/NumericVisa Debit8-position Alpha/Numeric8-position Alpha/NumericGrid ID(Client Use)MC Debit8-position Alpha/NumericDiscover NetworkTiered Grid ID(Client Use)Tiered Grid IDAUTHORIZATION GRID ID#:8-position Alpha/NumericUSER DEFINED GRID ID#:(Client Use)Discover NetworkTiered Grid ID(Client Use)Debit Tiered8-position Alpha/Numeric8-position Alpha/NumericGrid ID(Client Use)(Client Use)TIEREDDiscount Fees (Based on Gross Sales Volume)DiscountMPG TXN FeeDiscountMPG TXN FeeMC Qual Credit% VS Qual Credit% MC Mid-Qual Credit% VS Mid-Qual Credit% MC Non-Qual Credit% VS Non-Qual Credit% MC Worldcard Qual% VS Rewards 1% MC Worldcard Mid-Qual% VS Rewards 2% MC Worldcard Non-Qual% MC Qual Debit% VS Qual Debit% MC Mid-Qual Debit% VS Mid-Qual Debit% MC Non-Qual Debit% VS Non-Qual Debit% Discover Qual Credit% Discover Qual Debit% Discover Mid-Qual Credit% Discover Mid-Qual Debit% Discover Non-Qual Credit% Discover Non-Qual Debit% Pass Through Interchange - Includes Dues and AssessmentsOther Volume PercentDiscount Rate for Visa,MasterCard and Discover Creditand Debit(Based on Net Volume)%Pass Through Per Item Fee Pass-Through Rates: Your processing fees will be the "Other Volume Percent" and the current Interchange rate at the time you process the transaction.Interchange Rates are variable and are determined by how your transactions clear Interchange.PIN Based DebitPass Through Debit Network Fees (ETC Only)Other Item Rate nut!Creek,!CA(per item)Other Volume Percent% PIN Debit Trans Fee Page!!3!of!25

EQUIPMENT / SET-UPINTERNAL USE ONLYNoDoes Merchant need a MANUAL IMPRINTER?Yes, how manyDo you use any third party to store, process or transmit cardholder data?NoYes, if yes give name / address of vendor:Please identify any Software used for storing, transmitting, or processing Card Transactions or Authorization Requests:Internet GatewayYourPay.comOther:Wireless GatewayCellSwipeOther:Wireless Network:Dial LoadIP LoadOtherPC / Internet SoftwareQuantityNewRentLeaseExistingTerminal ModelQuantityNewRentLeaseExistingPrinter ModelQuantityNewRentLeaseExistingPIN PadQuantityNewRentLeaseExistingPay at the Pump Equipment:EBT INFORMATIONFINS #:Benefits Issuance AvailabilityYesElectronic Voucher Support:DaysHoursNoFood StampsCash BenefitsPurchase w / Cash BackPurchaseCash Withdrawal: If cash issuance, the limit amounteMerchantview ReportingYesNoClientline ReportingYesNoTip Line Required?YesNoYesNoDaily Auto BatchAuto Batch Time:Default is 11:59 PMMonthly Discount Rate DeductionSITE INSPECTION INFORMATION1- Location:RetailMallApprox Square footageApprox.OfficeTrade ShowHomeMobile MerchantINTERNAL USE ONLY8-9-4- Is business license visible?Return Policy:YesExchange OnlyStore CreditMC/Visa Credit10- Are Goods and Services Delivered at Time of Sale:Yes11-5- Are MasterCard / Visa Decals Visible:NoYesYes, which monthsHave you ever had a bankcard relationship terminated?NoFull RefundIs Inventory Sufficient for Business Type:YesIf no, why?No, explain:7-NoOther2- How many employees:3- How many Registers / Terminals:6- Seasonal MerchantYesAre customers required to leave a deposit for products or services?NoNoIf Yes, % of deposit required:%12- Your Previous Processor:RateCheck Reason for Leaving:Yes (if yes, attach explanation.)Terminated13-Please list all Website representing the merchant or any web sites owned by the merchant:14-Is site photo included with application?YesIf no, why?ServiceOtherNo, if not attach image from Google Earth at www.earth.google.comBy the signature below, I verify that I (i) have physically inspected the business premises: and that (ii) the information stated in this "Site Inspection Form" is correct tothe best of my knowledge and is as presented to me by merchant.Sales Representative Signature:Sales Representative Name (Please Print) :Application k,!CAPage!4!of!25

RANTORAll corporations and limited liability companies must have their obligations guaranteed. e!their!obligations!guaranteed.As a primary inducement to ank/Processor and TeleCheck and/or First ata Global easing, X!!!Signature!X!!!!Title! !!Date!!!Title! Walnut!Creek,!CAPage!24!of!25

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First Data Global Leasing will automatically debit the Lease Term Settlement Account identified on page 2 for all accounts owing under the lease. Total Monthly Lease Charge: W/o taxes, late fees, or other charges that may apply - See section 30 of your Merchant Agreement for details. Months Annual Tax Handling Fee: 10.20 FIRST DATA GLOBAL LEASING