Welcome to Tuition Express - Procare Software

First Regional BankNational Bank of CAFOR OFFICIAL USE ONLY21215 Burbank Blvd.Woodland Hills, California 913671-800-262-3246TYPE OF OWNERSHIP:Merchant Services ApplicationBUSINESS INFORMATION______ Partnership ______ LLC _____ Sole Proprietorship ______ Corporation _____ Non-ProfitLEGAL BUSINESS OR CORPORATE NAME: SALES I.D: SALES ORGANIZATION:0859 Professional Solutions“DOING BUSINESS AS” NAME:TYPE OF BUSINESS: (BE SPECIFIC)STOREFRONT ADDRESS: CITY: STATE: ZIP CODE:BILLING ADDRESS: CITY: STATE: ZIP CODE:BUSINESS PHONE NUMBER:( )CONTACT PERSON/TITLE:AGE OF BUSINESS: (YEARS)FAX NUMBER:( )FEDERAL TAX I.D. NUMBER:CONTACT PHONE NUMBER:( )NO. OF LOCATIONS:(If multiple, attach ‘Additional Location Form’)WEBSITE URL:SWIPED %: INTERNET %: PHONE ORDER %:CEO/PRESIDENT/OWNER:1.OWNER/OFFICER INFORMATION(not required for non-profits 501C organizations and Public Corporation)TITLE:% EQUITY OWNERSHIP:SOCIAL SECURITY NUMBER: DOB: HOME PHONE:( )RESIDENCE ADDRESS: CITY: STATE: ZIP:SECOND OFFICER OR CO-OWNER:2.TITLE:% EQUITY OWNERSHIP:SOCIAL SECURITY NUMBER: DOB: HOME PHONE:( )RESIDENCE ADDRESS: CITY: STATE: ZIP:PRODUCT AND FEE SCHEDULEMerchant hereby subscribes to the ECHO Merchant Services noted below and agrees to pay ECHO the applicable fees indicated, and, in the case of creditcard and off-line debit card transactions, Merchant agrees to pay the incremental fees identified. Merchant acknowledges such fees may be electronicallynetted from the proceeds of Merchant’s sales or debited from the Merchant Account. Fees not collected within the month of billing will accrue interest at themaximum rate allowed by law per month beginning on the first day of the month following the billing month until all fees and accrued interest are paid in full.CREDIT CARDSAVERAGE MONTHLY VOLUME: AVERAGE TICKET SIZE: AMERICAN EXPRESS: (Enter Merchant No.)Please Services Selected TRANSACTION FEE DISCOUNT FEE% CHARGEBACK / RETURN FEEVISA/MC/Discover ® Network - Retail $0.03 +$0.12* 1.79 $20.00AMEX - Retail $0.03VISA/MC/Discover ® Network - MOTO $0.03 +$0.12* 1.95 $20.00AMEX - MOTO $0.03*An additional $0.12 per item is added by Card associations.CREDIT CARD FEES FOR INDUSTRIES, CATEGORIES AND TRANSACTION CHARACTERISTICSElectronic Clearing House, Inc. (“ECHO”) is a registered ISO/MSP of First Regional Bank28632 Roadside Dr., Ste. 155, Agoura Hills, CA 91301, Ph (800) 777-0929, Member FDIC Initial: _________________ Date: _____________Electronic Clearing House, Inc. (“ECHO”) is a registered ISO/MSP of National Bank of California145 S. Fairfax Ave., Los Angeles, CA 90036, Ph (323) 655-6001, Member FDICLC0013- Standard ProCare 07-15-091