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Official Payments Corporation <br /> Required Local Client Information Profile <br /> Please help us board your agency by providing the following information. Upon completion, <br /> please fax the form back to the address at the bottom Thank you for supplying this information. <br /> CLIENT NAME: CITY OF TUKWILA MUNICIPAL COURT <br /> MAILING ADDRESS: 6200 SOUTHCENTER BLVD. SEATTLE, WA 98188 <br /> PHYSICAL ADDRESS: (IF DIFFERENT FROM MAILING ADDRESS) <br /> PRIMARY CONTACT NAME TITLE: LATRICIA KINLOW, COURT ADMINISTRATOR <br /> CONTACT PHONE /FAX E -MAIL: (206)433 7185/(206)433 -7160 tkinlow1,ci.tukwila.wa.us <br /> CARDS TO BE ACCEPTED: VISA: X MC: X AMEX: X DISC: X <br /> INTERNET PAYMENTS: nY N TELEPHONE PAYMENTS: I N <br /> PAYMENTS ACCEPTED: <br /> Official Payments Corporation (OPQ will be providing electronic payment processing services <br /> for your organization. For each payment type that you will be accepting at this point, please <br /> provide the requested detailed information below. <br /> Property Tax <br /> Annual Collections: Bill Mail Out Dates: <br /> Annual Number of Bills: Bill Due Dates: <br /> Reported for fiscal period: <br /> Email address for Daily Reports: <br /> Requested Info on Daily Report: <br /> Utility Payments <br /> Annual Collections: Average Bill Amount$ <br /> Annual Number of Bills: Bill Mail Out Dates: <br /> Reported for fiscal period: Bill Due Dates: <br /> Email address for Daily Reports: <br /> Requested Info on Daily Report: <br /> Parking /Moving Citations <br /> Annual Collections: $325,000.00 Average Bill Amount: $250.00 <br /> Annual Number of Citations: 6,906 Bill Mail out Dates: <br /> Reported for fiscal period: Bill Due Dates: <br /> Email address for Daily Reports: abell,ga,ci.tukwila.wa.us and tkinlow(a_),ci.tukwila.wa.us <br /> Requested Info on Daily Report: Citation payor's last name, amount paid, method of payment <br /> Other. Specify type of payment: BiII Mail out Dates: <br /> Annual Collections: Bill Due Dates: <br /> Annual Number of Bills: <br /> Reported for fiscal period: <br /> Email address for Daily Reports: <br /> Requested Info on Dail �eport: <br /> Client Signature: Date: �1��� �,'�7 <br /> Please FAX th�sform ack to: �%i1t'i;� <br /> G <br /> Sales Person Name: 4 <br /> Fax and E -Mail Address: 925- 855 -6093 =iaaonn officialpavments.coin <br />