Vantage Card Services, Inc.

2230 Towne Lake Parkway

Building 400, Suite 110
Woodstock, GA 30189
(800) 397-2380 | (770) 928-5688
Fax (770) 928-9328
www.vantagecard.com

MERCHANT MEMBER PACKAGE AGREEMENT & APPLICATION

Vantage MID

Company Info

Merchant Location Info

Business Legal Name

"Doing Business As" Name

[DEMO] Demo - Test Dollar Company 1

Legal Address

Location Address

No.1700, St. Avenue Paradise,

Legal Address 2

Location Address 2

City

City

State

State

Zip

Zip

Contact Name

Location Contact

Telephone Number

Location Telephone Number

Federal Tax ID Number

Web Site Address

Bus. Type (SCorp, LLC, Sole Prop)

Merchant Category Code

Mail Statements and Chargebacks

Legal
DBA
Other

Chargebacks

Mail

Austin
TX
560079
Sys Admin Bill.com
5123801088
8999

Location Fax Number

Chargeback Fax Number

Fax

Special Instructions

Member Bank (Acquirer) Information

Wells Fargo Bank, 1200 Montego, Walnut Creek, CA 94598 (925) 746-4167

Important Member Bank (Acquirer) Responsibilities

Important Merchant Responsibilities

1. The Bank is the only entity approved to extend acceptance of Card

Organization products directly to a Merchant.
2. The Bank must be a principal (signer) to the Merchant Agreement.
3. The Bank is responsible for educating Merchants on pertinent Card
Organization Rules with which Merchants must comply: but this information
may be provided to you by Processor.
4. The Bank is responsible for and must provide settlement funds to the
Merchant.
5. The Bank is responsible for all funds held in reserve.

1. Ensure compliance with cardholder data security and storage

requirements.
2. Maintain fraud and chargebacks below Card Organization thresholds.
3. Review and understand the terms of the Merchant Agreement.
4. Comply with Card Organization Rules.
5. Retain a signed copy of this Disclosure Page.

Merchant Resources
You may download Visa Regulations from Visas website at:

http://usa.visa.com/merchatns/operations/op_regulations.html

You may download MasterCard Rules from MasterCards website at:

http:///www.mastercard.com/us/merchant/support/rules.html
You may download additional merchant information from Discovers website
at: http://www.discovernetwork.com/merchants/index.html
You may download American Express Merchant Operating Requirements
at https://globalpaymentsinc.com/GPDB/AccessDOC.aspx?
SubDoc_ID=1393

The responsibilities above do not replace the terms of the Merchant

Agreement and are provided to ensure the Merchant understands some
important obligations of each party and that the Bank is the ultimate
authority should the Merchant experience any problems.

X
Merchants Signature

Name (print)
Proposal ID

33580

Site ID

Title

bill.merchantrates.com

Vantage Card Services, Inc. | http://vantagecard.com | 800-397-2380

v. 05/15-VCS-WF

p.1

Fax Completed Application to 770-928-9328

Date

Merchant Name

[DEMO] Demo - Test Dollar Company 1

Signer Info (Please complete for every person who has 25% or more ownership or persons with authority/control, when percentage of ownership is
not applicable)
Owner / Officer Name

Title

Social Security Number

% of Ownership

Home Address

Home Phone

City

State

Zip

Email Address

bill.comsysadmin@conseroglobal.com

Politically Exposed Persons require more due diligence under anti-corruption and anti-money laundering compliance:
Is any owner, officer, director, employee, or agent a current or former senior official in the executive, legislative, administrative,
military, or judicial branch of any government (elected or not); a senior official of a major political party; an executive of a
government-owned commercial enterprise; a family member of any of the foregoing officials; or a close personal or professional
associate of any of the foregoing officials? If yes please attach details.

Yes
No

Merchant Trade References

Bill.com

Trade Reference 1

Contact Name

Trade Reference 2

Customer Service

Contact Name

Telephone

877-345-2455

Telephone

Tell us about your business

Goods/Services Sold

Future Delivery

# of locations

Seasonal Sales

Business Est. Date

Annual Bankcard Sales

No

Current Owner Date

Average Transaction $

$7,200.00
$600.00

% of Non-Swipe Sales

Premises Inspection
Building Type

Office | Shopping | Stand Alone | Residence | Other

Landlord Name

Landlord Phone

Neighboring Businesses

Premises is

Own | Lease

Square Footage

250 | 500 | 2000 | >2000

Risk Review Status

Business signage visible?

Yes
No

Business currently operating?

Yes
No

Have you previously accepted card payments?

Yes
No

Merchant name consistent with signage?

Yes
No

Are you currently accepting card payments?

Yes
No

Applicable inventory present?

Yes
No

Ever declared business or personal bankruptcy?

Yes
No

Does the merchant use fulfillment house?

Yes
No

Ever been terminated from accepting card payments?

Yes
No

If yes, was the fulfillment house inspected

Yes
No

Card numbers accepted electronically over the Internet?

Yes
No

Are card acceptance decals visible?

Yes
No

AmEx annual volume < $1,000,000

Yes
No

AmEx Acceptance

Yes
No

AmEx Marketing

Yes
No

Personal Guaranty
I/We hereby irrevocably guarantee to Global Direct and Member, their successors and assigns, the full, prompt, and complete performance of Merchant
and all of Merchant's obligations under the Card Services Agreement, including but not limited to all monetary obligations arising out of Merchant's
performance or non-performance under the Card Services Agreement, whether arising before or after termination of the Card Services Agreement.
This guaranty shall not be discharged or otherwise affected by any waiver, indulgence, compromise, settlement, extension of credit, or variation of terms
of the Card Services Agreement made by or agreed to by Global Direct, Member and/or Merchant. I/We hereby waive any notice of acceptance of this
guaranty, notice of non-payment or nonperformance of any provision of the Card Services Agreement by Merchant, and all other notices or demands
regarding the Card Services Agreement. I/We agree to promptly provide to Global Direct and Member any information requested by any of them from
time to time concerning my/our financial condition(s), business history, business relationships, and employment information. I/We agree that Global
Direct and Global Direct (on behalf of Member) may order a consumer credit report on me, Merchant and each of Merchants officers, partners, and/or
owners, as well as subsequent consumer credit reports, which may be required or used in conjunction with the maintenance, updating, renewal or
extension of the services provided hereunder, or in conjunction with reviewing, taking collection action on, or other legitimate purposes associated with
the Merchant account. I/We have read, understand, and agree to be bound by the Card Services Terms & Conditions provided to Merchant and those
terms and conditions contained in this Merchant Application.
An individual

X
Signature of Guarantor

X
Signature of Guarantor

An individual

Signature of Witness

x
Reviewed by Vantage Card Services, Inc.

Proposal ID

33580

Site ID

bill.merchantrates.com

Vantage Card Services, Inc. | http://vantagecard.com | 800-397-2380

v. 05/15-VCS-WF

p.2

Fax Completed Application to 770-928-9328

An individual

Merchant Name

[DEMO] Demo - Test Dollar Company 1

Vantage MID

Rate & Fee Disclosure

Primarily

Card Type

Card Present

Visa Credit

Card Not Present

Visa Debit

Rate

Check all that apply

MasterCard Credit

0.10%
0.10%
0.10%
0.10%
0.10%
0.10%
0.10%

Auth

/ Item

$0.070
$0.070
$0.070
$0.070
$0.070
$0.070
$0.070

Other Fees
Annual Membership
Monthly Statement
Minimum Monthly

Retail

MasterCard Debit

Restaurant / QSR

Discover Credit

Level 3

Discover Debit

eCommerce

PayPal Credit Card Present

MOTO

EBT

Bank Admin Fee

Wireless / Mobile

PIN Debit

FANF Fee

____________

China Union Pay

PCI DSS Fee Compliance

American Express

PCI DSS Non-Compliance

AVS Authorization
Chargeback / NSF
Touch Tone Auth

Regulatory Compliance

Assoc # _______
Chain # _______

Voice Authorization

$0.00
$10.00
$0.00
$0.55
$0.00
$20.00
$0.00
$0.00
$2.82
$4.95
$9.95

$1.95

Pass-Through Interchange, Dues, Assessments, Access, Acquirer, License Fees

Transactions that do not qualify for the most favorable interchange rates will be subject to increased interchange rates. See section
32 the Card Services Terms and Conditions for more information regarding the circumstances in which increased interchange rates
may apply. Discount rates and other percentage fees are calculated by multiplying the rates or fees and the Merchants applicable
transaction volume. Per item and per authorization fees are calculated per transaction or authorization, as applicable. In addition
to the per item fee, all Debit transactions include fees assessed by the applicable network organization.
MasterCard Association Fees and Assessments (per occurrence fees marked with a *)
* MC Cross Board US Re Acq 1%; w/Cred 0.60%

* MC Account Status Inquiry Fee $0.030

* MC Acquirer Support Fee 0.85% (non US)

* MC Assessments 0.14%

* MC Network Access Fee $0.0195

* MC Assessments Large Ticket 0.16%

* MC Misuse of Auth System $0.055

* MC Acceptance & License Fee $0.00
* MC CVC2 Transaction Fee $0.0025

Visa Association Fees & Assessments (per occurrence fees marked with a *)
* Visa APF Credit $0.0195; Debit $0.0155

* Visa International Service Assmnt Fee 0.80%

* Visa Misuse of Auth System $0.045

* Visa International Acquirer Fee 0.45%

* Visa International Service Assmnt Enhanced 1.20%

* Visa AVS Only Fee $0.025

* Visa Zero Dollar Verification Fee $0.10

* Visa Assessments Credit 0.16% Debit 0.14%

* Visa Transaction Integrity Fee $0.10

Discover Association Fees & Assessments (per occurrence fees marked with a *)
* Discover International Processing 0.50%

* Discover International Service Fee 0.80%

Discover Assessments 0.13%; Access Fee $0.0195

American Express Association Fees & Assessments (per occurrence fees marked with a *)
* AmEx Non-Swiped Tran Fee 0.30%

* AmEx Inbound Fee 0.40%

AmEx Network & Processor Fee 0.25%

* AmEx Non-Swiped M Initiated Fee 0.30%

PayPal Association Fees & Assessments (per occurrence fees marked with a *)
* PayPal Auth Participation Fee 0.10%
Proposal ID

PayPal Participation Fee $0.0185

33580

Site ID

bill.merchantrates.com

Vantage Card Services, Inc. | http://vantagecard.com | 800-397-2380

v. 05/15-VCS-WF

p.3

Fax Completed Application to 770-928-9328

Merchant Initials

Merchant Name

[DEMO] Demo - Test Dollar Company 1

ACCEPTANCE OF TERMS & CONDITIONS / MERCHANT AUTHORIZATION

Your Card Services Agreement is between Global Payments Direct, Inc. ("Global Direct"), the Merchant named above, and the Member named
below ("Member"). Member is a member of Visa, USA, Inc. ("Visa") and MasterCard International, Inc. ("MasterCard"); Global Direct is a registered
independent sales organization of Visa, a member service provider of MasterCard and a registered acquirer for Discover Financial Services, LLC.
("Discover") and a registered Program Participant of American Express Travel Related Services Company, Inc. (American Express).
A copy of the Card Services Terms and Conditions, revision number 05/15-VCS-WF, has been provided to you. Please sign below to signify
that you have received a copy of the Card Services Terms & Conditions and that you agree to all terms and conditions contained therein. If this
Merchant Application is accepted for card services, Merchant agrees to comply with the Merchant Application and the Card Services Terms &
Conditions as may be modified or amended in the future. If you disagree with any Card Services Terms & Conditions, do not accept service.
IF MERCHANT SUBMITS A TRANSACTION TO GLOBAL DIRECT HEREUNDER, MERCHANT WILL BE DEEMED TO HAVE ACCEPTED
THE CARD SERVICES TERMS & CONDITIONS.
Application must be signed by Owner if Sole Proprietorship or; Partners/Officers with greater than 50% combined Ownership if Partnership or
Corporation. By your signature below on behalf of Merchant, you certify that all information provided in this Merchant Application is true and
accurate and you authorize Global Direct, and Global Direct on Member's behalf, to initiate debit entries to Merchant's checking account(s) in
accordance with the Card Services Terms and Conditions. In addition by adding your signature below on behalf of Merchant you authorize Global
Direct and/or Vantage Card Services, Inc. to order a consumer credit report on you, Merchant and each of Merchants officers, partners, and/or
owners, as well as subsequent consumer credit reports, which may be required or used in conjunction with the maintenance, updating, renewal
or extension of the services provided hereunder, or in conjunction with reviewing, taking collection action on, or other legitimate purposes associated
with the Merchant Account.

X
Merchants Signature

Name (print)

Title

Date

Name (print)

Title

Date

Name (print)

Title

Date

Name (print)

Wells Fargo Bank

Date

X
Merchants Signature
x
Signing for Global Payments Direct, Inc.
x
Signing for Member

Direct ACH Credits & Debits Authorization Agreement

I hereby authorize Vantage Card Services, Inc. to initiate credit and debit entries to my checking account indicated below at the depository financial
institution named below. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This
authorization is to remain in full force and effect until Vantage Card Services, Inc. has received written notification of termination in such time and in
such manner as to afford Vantage Card Services, Inc. and Bank a reasonable opportunity to act on it. Note: All written credit and debit authorizations
must provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization.

Bank Info

Include copy of a Voided Check or Bank Letter

Bank Name

Include copy of Current Merchant Statement

Bank Contact

Include copy of your Business License

Bank Phone
Bank Account Type
For Office Use

Bank Routing #
Bank Account #

Signature X

Date

Billing disputes must be forwarded, in writing, to Customer Service within 60 days of the date of the statement and/or notice.

Proposal ID

33580

Site ID

bill.merchantrates.com

Vantage Card Services, Inc. | http://vantagecard.com | 800-397-2380

v. 05/15-VCS-WF

p.4

Fax Completed Application to 770-928-9328

Merchant Name

[DEMO] Demo - Test Dollar Company 1

Please visit www.vantagecard.com/pci for more on PCI related services.

Cardholder Data Storage Compliance & Service Provider

PCI DSS and card association rules prohibit storage of track data under any circumstances. If you or your POS system pass,
transmit, store or receive full cardholder data, then the POS software must be PA DSS (Payment Application Data Security
Standard) compliant or you (merchant) must validate PCI DSS (Payment Card Industry Data Security Standard) compliance.
If you use a payment gateway, they must be PCI DSS compliant.
1.

Have you ever experience an Account Data Compromise "ADC"?
Yes
No
If yes, provide date of compromise?_______________
a) Have you validated PCI DSS compliance in the last 12 months?
Yes
No
If yes, go to 1(b); If no go to #2
b) Date of compliance, Report on Compliance "ROC" or Self Assessment Questionnaire "SAQ"? _________
c) What is the name of your Qualified Security Assessor "QSA" _______________ and Self Assessment
Questionnaire ("SAQ")
A
B
C
D
d) Date of last scan:_______________
Approved Scanning Vendor's name: _____________________

2.

As required under the Payment Card Industry Data Security Standard (PCI DSS), Merchant declares and confirms the
following:
a) Merchant is in compliance with all PCI DSS requirements.
Yes
No
b) Merchants point of sale software, systems or applications, do not store sensitive authentication data or any evidence of
magnetic stripe data, or PIN data after transaction authorization is complete.
Yes
No
c) Merchant will maintain full PCI DSS compliance at all times and will notify Global Payments when it changes its point of
sale software, system or application.
Yes
No

3.

Are you using a "dial-up" terminal or "TTC" Touch Tone Capture, or virtual terminal or software from Global Payments?

Yes

No

4.

Do your transactions process through any other Service Provider (i.e. web hosting companies, gateways, corporate office)?

Yes

No

If you answered no to question 4, please initial below, if you answered yes, then please continue.
5.

6.

What Primary Service Provider/Software Developer did you purchase your point of sale "POS" application from
Vantage Card Services
(ie software gateway)? ________
PayTrace
a) What is the name of the Service Provider/Software Developer's software application? ___________________
Software Version #? ___________
b) Do your transactions process through any other Service Provider (i.e. web hosting companies, gateways, corporate
office)?
Yes

No
c) If yes, name the other Service Provider? ___________________________ If no, however, merchant is electronic
commerce, please provide name of ISP (web host): ________________
Do you or your Service Provider(s) receive, pass, transmit or store the Full Cardholder Number "FCN", electronically?

No
If yes, where is card data stored?
Merchant location only
Merchant's Headquarters/Corp office only

Primary Service Provider
Both Merchant and Service Provider(s)

Other Service Provider
All Apply

Yes

Proposal ID

33580

Site ID

bill.merchantrates.com

Vantage Card Services, Inc. | http://vantagecard.com | 800-397-2380

v. 05/15-VCS-WF

p.5

Fax Completed Application to 770-928-9328

Merchant Initials

Merchant Name

[DEMO] Demo - Test Dollar Company 1

Terminal Network Services

Global Terminal Capture

Network
POS System

Contact

Global Host Capture

Phone #

Vital

Version #

Communication

PayTrace

Dial

IP
VPN

Terminal

Type

Quantity

Price

Total

Terms

NA

Buy
Rent
Own

Three Pay Purchase

Total Due

NA

Note: All Purchases carry a one year warranty. Merchant expressly acknowledges that ALL rental or loaned equipment is and shall remain the property
of Vantage Card Services, Inc. and any rental or loaned equipment not returned upon request and any damaged rental or loaned equipment returned
will be billed at a maximum of $500/per unit replacement price. The business checking account attached for card processing will be ACH debited for
supply orders and equipment fees due.

Programming

Retail

Restaurant

Options

Server #

Invoice #

AVS

CVV2

Set Up

All Sales Final

Auto Close Time: ________

Signature Capture $9.95/mo

Programming Notes

Activate API in Bill.com

Tax Amount
Terminal Communication Method

WiFi (Secure wireless router WAP2 configuration separate from any public use)

IP

(Ethernet cable from your router to your sales counter not provided)

Dial (Dial service must be from an analog line (not digital or VoIP) and add $0.01/per Authorization if primary comm method)

NA

PABX Dial Number (ex. Dial a 9 to get an outside line) ______
Additional Services Type

Activation

Mo. Access

Per Item

$35.00

$10.00

$0.04

Notes

Internet Gateway

PayTrace

Level 3 Gateway

* Please note Gateway Set Up by location as:
Retail/Swipe
Virtual Terminal Only
eCommerce/VT

GPRS SIM

Check Services

See separate application

Gift / Loyalty

See separate application

Vantage Points Rewards
* Must have email address on file to enroll and maintain participation in the Vantage Points rewards program.
Visit http://www.vantagecard.com/rewards for more on this free program.
Vantage Agent

Agent ID

Referral Source

Bill.com

X
Name (print)

Merchants Signature
Proposal ID

33580

Site ID

Title

bill.merchantrates.com

Vantage Card Services, Inc. | http://vantagecard.com | 800-397-2380

v. 05/15-VCS-WF

p.6

Fax Completed Application to 770-928-9328

Date