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INSTRUCTIONS FOR COMPLETING THE APPUCATION ALL INFORMATION INDICATED BELOW MUST BE COMPLETED BEFORE SUBMITTING THE APPUCATION. 1. APPLICATION TYPE . NEW MERCHANT- . ADDmONAL LOCATION- 2. Indicate if you are a new Merchant of BA Merchant Services. If you dedde to submit additional locations in the future, complete a new Application and return the form to BA Merchant Services. If more than one location is initially being implemented, please complete the Multiple Locations Addendum. I If you decide to change any of your existing informab'on in the future, please contad 84 Merchant Services for the required documentation. MERCHANT BUSINESS INFORMATION · Indude all information pertaining to the legal entity executing the Application and Agreements. Also list all "d/b/a" names used in the business. I LEGAL BUSINESS NAME AND MANAGEMENT INFORMATION · Include all information pertaining to the corporate or parent ownership of the merchant, if different from the information listed in Section #2. If the information is the same as the information in Section #2, you will need only to indicate "Same as above." OWNER/OFFICER INFORMATION · Provide all the requested Owner/Officer information. If the Merchant operates as a proprietorship, partnership or dosely held corporation, then information about the Owner(s) must be supplied. MERCHANT BANK ACCOUNT INFORMATION · Indicate the finandal institution in which BA Merchant Services is to settle your funds. An imprinted, encoded, voided check (not a temporary check) or Verification of Account Letter from your deposit bank must be attached to the Application to initiate distribution of your funds only if your deposit bank is not Bank of America. BUSINESS CERTIFICATION CERTIFICATION OF MERCHANT'S CARD PROCESSING ACTlVITY · Indicate your antidpated percentage of cards presented and cards not present, and indicate your anticipated percentage of MO{rO% (Catalog) (percentage of Mail-order or Telephone Order transactions), Intemet% (percentage of Internet transactions), Card Swiped ancl Hand Entered transactions. · Provide your current Processor name, the reason for the change, your current/previous Merchant # and submit 3-6 months current processing statements . Indicate whether your business is seasonal and the active months, if applicable. . Provide your average ticket and monthly and annual volumes over a 12-month period. If the totals vary by location, make sure to note the individual location's totals on the Multiple Locations Addendum. TRADE REFERENCE . Provide a Trade Reference for BA Merchant Services to verify credit information CERTIFICATION OF MERCHANT'S BUSINESS YEARS/MONTHS IN BUSINESS- Indicate the number of years in which the business has been operating . YEARS UNDER CURRENT OWNERSHIP- Indicate the number of years in which the business has been under the current ownership . BUSINESS TYPE- Indicate the type of goods sold . FORM OF OWNERSHIP- Indicate the ownership status . BUSINESS ENVIRONMENT-Indicate the business environment of the business location ADDmONAL INFORMATION FOR USE BY ACCOUNT EXECUTlVE ONLY EOUIPMENT AND PROCESSING SPECIFICATIONS (COMPLETE WITH SALES REPRESENTATIVEl MERCHANT TYPE . Indicate processing type using options provided TERMINAL TELEPHONE UNE & MERCHANT TRAINING INFORMATION . Indicate whether type of service requested is tone or rotary (dial), or if using a non-tone or rotary solution, then select "IP" . Indicate whether BA Merchant Services is to train the Merchant and, if applicable, the training information. EQUIPMENT INFORMATION . Please complete the information for the terminals, equipment and miscellaneous items. OPTIONAL PRINT UNES FOR THE RECEIPT IN THE HEADER/FOOTER . Indicate pt and 2nd lines of receipt header. . Provide site address for equipment delivery if different than the address in Merchant Business Information section. REFERRAL TO BPS (OPTIONALl . Indicate whether you agree or disagree to provide the information listed on the Application to Best Payment Solutions, Inc. if BA Merchant Services declines your application. Be sure to initial this section. GENERAL PROVISIONS . Please review the provisions listed herein prior to signing the Application. I 3. 4. 5. 6. 7. Tbe Application must be fully executed and initialed where indicated. Please retain a copy of the entire Application (including the attached Agreements) for your files. TO RETURN YOUR APPUCATION - Please return the following items to BA Merchant Services at the address indicated below. If you have questions, please contact BA Merchant Services Customer Service. 1. SA Merchant Services' copy of the Application 2. If applicable, a check made payable to "BA Merchant Services" for purchased equipment and all applicable fees 3. If applicable, a check made payable to the rental or leasing company for rented or leased equipment 4. A voided check for the bank account in which BA Merchant Services is to deposit your funds (if not a Bank of America account) 5. Current 3 months processing statements from your existing processor MAIL TO - BA MERCHANT SERVICES 1231 DURRETT LANE LOUISVILLE, KY 40213 A TTN: ACCOUNT BOARDING BAMS MSA (8-2-05) I Page 2 of 19