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<br />BanI< of America, N.A. <br /> <br />I <br /> <br />Bank 01 America ~ <br />~ <br /> <br />Please provide the information requested below BOd forward to YOW" sales representative or client relations <br />manager. Keep a copy for YOW" records. <br /> <br />Legal business name <br /> <br />DBA name <br /> <br />Merchant signature <br /> <br />By signing below, the Merchant named above (1) acknowledges receipt of the addendum/stand-alone <br />agreement booklet entitled "Addendum/ Agreement to MerchBOt Card Services for Electronic Check <br />Service" Agreement (2) agrees that Merchant BOd each Electronic Check Service transaction submitted <br />to Bank of America, N .A. ("BA") will be bound by the lenDs BOd conditiODS in that Agreement. <br /> <br /> <br />_....}.n;;..'ry _ <br />o ~r./ t..")' G.~~ J /Ilot Olr <br />Print namcltitle <br /> <br />I <br /> <br /> <br />-~ <br /> <br /> <br />Ba.i:Jk of America, N.A. <br />YO~N 1'1 r {t-R. p)()tJ~- ~J ( <br />Print namcltitle <br /> <br />Guarantor signature <br /> <br />o Check bere if the applicant is requesting Electronic Check Service only BOd is a privately held <br />corporation, limited partncmnp or a limited-liability company. If so, the principal owocr(s) must <br />sign below, agreeing to the Continuing Guaranty provided in the Agreement. <br /> <br />Guanmtor signature <br /> <br />Date <br /> <br />Print namcltitle <br /> <br />~ <br /> <br />Merchant Services copy <br /> <br />I <br />