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<br />I <br /> <br /><<'I <br />..;.-"~c., <br /> <br /> <br />Bank of America, N.A. <br /> <br />Banko' America ~ <br />~ <br /> <br />Please provide the information requested below and forward to your sales representative or client relations <br />II1llDlI8er. Keep a copy for your records. <br /> <br />Legal business name <br /> <br />DBA name <br /> <br />Merchant signature <br /> <br />By signing below, the Merchant named above (I) acknowledges receipt of the addendum/stand-alone <br />agreement booklet entitled "Addendum/Agreement to Merchant Card Services for Electronic Check <br />Service" Agreement (2) agrees that Merchant and each Electronic Check Service transaction submitted <br />to Bank of America, N.A. ("BA") will be bound by the terms and conditions in that Agreement <br /> <br />J ,\)tf <br /> <br />Merchant signature <br /> <br />----D ~,J [;; ~7 <br />Print name/title <br /> <br />Date <br /> <br />J /Ifp ( C1fI' <br /> <br />Bank of A'J)frica. N.A. Signat~ / <br />'/jJj 1,J 14, cL It lJ lhU <br />Bank of America, N.A. <br />-::-.D () to rJ It C' /+E (J}/) rJ 1:::: S 11 <br />Print name/title <br /> <br />.3 <br /> <br /> <br />Date <br /> <br />Guarantor signature <br /> <br />D Check here if the applicant is requesting Electronic Check Service only and is a privately held <br />corporation, limited partnership or a limited-liability company. If sa, the principal owner(s) must <br />sign below, agreeing to the Continuing Guaranty provided in the Agreement. <br /> <br />Guarantor signature <br /> <br />Date <br /> <br />Print name/title <br /> <br />~ <br /> <br />Merchant copy <br />