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<br /> <br />AP:pLICAIIQN <br /> <br />BA Merchant Services <br /> <br />SALES CODE <br /> <br />MID <br /> <br /> <br />New Merchant rn Additional Location 0 Location # _ of_ <br />If more than one (1) retail location, please complete the Multiple Locations Addendum. <br /> <br />~!~",M~B,,~,IIlN1 ~!l~~$~Jml,q~~l~~~~; <br />LEGAL BUSINESS NAME CITY OF SAN MARCOS <br />DBANAME N/A <br />PHYSICAL ADDRESS (INCLUDE CITY, COUNTY,STATEAND ZIP) 630 E HOPKINS <br /> <br /> <br />CONTACTNAME RENAE SASSENHAf:j <br /> <br />MAILING ADDRESS (INCLUDE CITY, COUNTY, STATE AND ZIP) SAN MARCOS. TX 78666 <br /> <br />PRIMARY TELEPHONE (512) 393-8180 ALTERNATE TELEPHONE (512) 393-8170 FAX (512) 392-4612 <br />E-MAn..ADDRESS SASSENHAGEN RENAElID.CI.SAN-MARCOS.TX.US CUSTOMER SERVICE PHONE # (512) 393-8170 <br />INTERNET WEBPAGEADDRESS WWW.CI.SAN-MARCOS.TX.US FEDERAL TAX ID 74-6002238 <br /> <br />CORPORATEIPARENT OWNERS~ <br />If different than above-lisledillfotn'llItlon <br /> <br />NAME CITY OF SAN MARCOS <br />ADDRESS 630 E HOPKINS <br />CITY SAN MARCOS <br />TELEPHONE (512 )393-8180 <br />FAX ( 512 )392-4612 <br /> <br />CONTACTNAME RENAE SASSENHAGEN <br /> <br />STATE TX ZIP 78666 <br />ALTERNATE TELEPHONE (512 ) 393-8170 <br />E_MAILADDRESSSASSENHAGENRENAE(Ci2CI.SAN-MARCOS.TX.US <br /> <br />IJ Statements 10 be sent 10 corporate/parent ",ther than primary ad""'ss listed above. <br /> <br /> <br />OWNER/OfFICER INFORMATION <br />Information on the individual(s) sigDingthe AppliCJItion must be provided below (QwDen listed below must total at least Sl~ownen"ip) <br />If infoii1latioll on more than two owners is uired lease attach the Additional Owner/Officer Forni.. <br /> <br />TNAME,MI,LASTNAME NA 1ZI0WNER(%Ownenbip <br /> <br />TITLE NA DATE OF BIRTH: o OFFICER <br /> <br />0.00 ) <br /> <br />HOME ADDRESS NA <br /> <br />HOW LONG AT PRESENT ADDRESS 0 <br />TELEPHONE (000) 000-0000 <br /> <br />CITY NA <br /> <br />STATE TX ZIP 78666 <br /> <br />2. FIRST NAME, MI, LAST NAME <br />Tln.E <br /> <br />OWN 0 RENT D DRIVERSLlCENSE# 000000 STATE ISSUED TX <br /> <br />SOC. SEC. # 000-00-0000 OWNER SINCE (MM/YY) 07 n7 <br /> <br />DOWNER (% Ownership <br />DATE OF BIRTH: o OFFICER <br /> <br />HOME ADDRESS <br /> <br />CITY <br /> <br />STATE <br /> <br />ZIP <br /> <br />HOW LONG AT PRESENT ADDRESS <br /> <br />OWN IJ RENT D <br /> <br />DRIVERS LICENSE # <br /> <br />STATE ISSUED <br /> <br />TELEPHONE SOC. SEe, # OWNER SINCE (MMlYY) <br /> <br />MERCHANT BANK ACCOUNT INFORMATION <br />o Imprinted Check Attached 0 VerifiCation of Account Letter from Bank Attached Unless Ihis is a Bank of America Account, an <br />1m rinted, Encoded Voided check or Verification of Account Let1er from Bank must be at1ached. If not rovided account cannot be set u <br /> <br />FINANCIAL INSTITUTION BANK OF AMERICA CONTACTNAME SUSAN SUTTON <br /> <br />S'ffiEET ADDRESS 515 CONGRESS AVENUE LENGTH OF RELATIONSHIP 0 <br /> <br /> <br />CITY AUSTIN <br /> <br />STATE TX <br /> <br /> <br />ZIP 78701 <br /> <br />PHONE ( 512 ) 397-2002 <br /> <br /> <br />ACCOUNT# 0 0 4 8 8 <br />The above-listedaccounl ",ill be the~ettlement Account as set forth in tile Merellant Services AgreemenL <br />o Does the Merchantbave a Bank of America Accoullt? If different from account listedllbove,please list in the fields provided below; <br />CONTACT NAME <br /> <br />ACCOUNT # I <br /> <br /> <br />BAMS MSA Application (8-2-05) <br /> <br />Page I of 5 of Application <br />