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HomeMy WebLinkAbout10-100 - US Bank - Tukwila Pool Credit Card Processing U.S. Bank Merchant Payment Services 10-100 INFORMATION CHECKLIST Council Approval N/A Please provide the following supporting information to assist us in establishing your new ;merchant account. Existing Merchant Numbers with Elavon (NOVA) 210230758992 0230758997 US Bank Merchant Services or Chain Number Corporate/ Legal Name: City of Tukwila Telephone and Fax Number: (206)433 -1835 (206)433 -1833 Physical Address: 6200 Southcenter Blvd Contact Name: Tukwila, WA 98188 Laurie Anderson Business Legal Form (ex; Corp, Govt, LLC): I Government I Business DBA Name: DBA Physical Street Address: I Telephone and Fax Number: Contact Person (client) Laurie Anderson Name /Telephone (206)433 -1835 Email IandersonOci.tukwila.wa.us Billing Address (address where we would send Same monthly merchant statement information to): Web Address to obtain financials I www.ci.tukwila.wa.us Federal Tax ID Number 91- 6001519 Phone Number cardholders can call w/ questions (206)433 -1835 about charges US Bank Checking Account Number: 153501052069 (For Deposit Settlement /Fee Billing) ...if another financial institution name please I Routing Number 1 125000105 I Estimated Annual Visa /MC Volume: 1 90722.41 Estimated Average Transaction Amount: I Vary from $3 transactions to $600 transactions Equipment(Manufacturer /Model): Tender Retail multi Payment Server 2.0 integrated Quantity: with Class Vendor is Active Network. Owned /Purchases /Rented /Lease: If Purchasing /Leasing (please provide Tax Exempt Certificate) POS Provider(Name /Version) Is a "pre -fix (8/9)" needed to dial out? Transaction Type (Swiped, Key Entered, Internet, Swiped, Telephone, Key Entered Mail, Telephone) Discover Merchant Number American Express Merchant Number Pool Fees Type of Payments (i.e. Taxes, Permits etc) Website URL, Internet merchants only I N/A Signers (2 names /titles) Rh da Berry; City rnini r for S n Hunstck; F' erector �Q ,(Vh "Ks If you have any questions regarding this Check List, please contact me at (503/693.6406), or fax me (503/693.6450). I am also available by e-mail at michael.hodge @elavon.com 6 .---1 v 1 Page 5 of 9 „,..6,, 9(i, 0 New Location I in Additional Location I Existing MID: 022147999110230753997 I Chain I Location of 1 r ',2- 1 .M :I4. r :l M"," i 1 ,:t .i ;;C: I ODA Name: City of Tukwila 43 I GBA Phone (206)4334835 I Ext. Contact Name: Laurie Anderson i DBA Fax IP (206)4334833 DBA Address 1 6200 Southeenter Blvd I Customer Service Phone* 006)433-1835 DBA Address 2. Email Address: landerson@ci.tukwila.wa.us City: Tukwila I State: WA I Zip Code: 98188 Federal Tax ID: 918001519 previous Processor: I Year Established: i Legal/Corporate Name: I Legal/Corporate Phone 4: I Ext. I Legal/Corporate Contact Name: 1 Legal/Corporate Fax Legal/Corporate Address: City: I State: I Zip Code: Government 0 Non-Profit Charitable or Social (include documents that support Tax Exempt Status) 0 Other__ infii0 Manager 0Aetharized Representative 0 Other Title Firrance First Name: Shawn Last Name: Hunstock Contact Address: 6200 Southcentor Blvd i Contact Phone (206)433-1835 i ••1 City Tukwila i Slate: WA I Zip Code_ 98188 Email Address: shunstock@ci.tukwitema.os i I I Average Sate Amount: 3 10 Description of product or serves offered: Pool Fees s,i_l Total Monthly Visa/MC/DISC Sales: 8000 MCC: 9399 Card Present (swiped) 95 For Card Present Transactions, when does the customer receive the product or service? Card Present not swiped) 5 (E1 Same Day 0 if not same day, of Days (include shipping time frame) Mail Order For Card Not Present Transactions, when does the customer receive the product or service? Telephone Order 0 Same Day 0 It not same day, 4 of Days (include snipping time frame) Internet For Internet Transactions, list theproduct web site: Total 100% Do you operate seasonally. 0 Yes 0 No If yes, please check months closed: .:•i 0 January 0 February 0 March 0 April 0 May 0 June 0 July 0 August 0 September 0 October 0 November 0 December I (Chocking Accounts only Deposit Bank Name: U.S. Bank i ABA/Routing 125000105 DDA Account It 153501052069 Billing Bank Name (if different): ABA/Routing 4: I DDA Account it: I USBGOV 032009 fite://C: \temp APGrp Wise \49DC9792tuk-mailIT-Post10016F61311AB381 GWI 00001.H... 04/08/2009 Page 4 of 9 Please check each card you wish to accept, Note acceptance lif Witt types notsekctod est! re=thn diaceanf GAN caoradae 'f 0 Retail 0 Lodging 0 Pay at Pump All Visa/MasterCard/Discover Cards 0 Restaurant 0 Supermarket 1 0 Visa Credit 1:1 Visa Debit 0 MO/TO Internet 0 ARU 0 MasterCard Credit 0 MasterCard Debit 0 Discover 0 TIERED Rate Per item 1 Per Authorization Per Sera '1 One Time Fee Type 4-- Qualified 1 Visa 1, ',I Appficalion Fee 1 MIcl-Qual oh, MasterCard Installation/Training 1 Non-Qual Discover 1. Wireless Set-Up Fee I Opt. 0 Debit 0 Supermarket 0 Quick Pay/Small Tkt WEX I,' Rush Shipment [I I Other 1::;. OtiCer Opt Rewards Tier Other: 1 'I: Monthly Fee Type Opt Commercial Card Tier Other I --,1 Statement Fee 0 INT Differential Plus PIN Debit A ztions: Minimum Discount I $25 uthoria VISA Qual Other: I MasterCard -Qual DINT PLUS/ASSOC :.4 Other. .-i----..•:- Nimetsty,ICPWS1 Discover -Qual 1 Voice Authorizations: Per Occurrence Fee Type I Non-Qual I ARU Chargeback Fee 1 $25 I INT PLUS 0.216 $0.04 Operator Assisted $0.90 Return Item (NSF) Fee 1 $20 Program _rncinp g Weirta■Td far 1D: AVS W.90 PCI Fee (Annual): ri Above Rates are far all Card Acceptance types seldcttni: 1 1 Bank Refenal $4.00 '1 Other i i 7 VikR Service Provider (Hostoth: Gateway foptionap 1 VAR V (Distributed): 1 VAR Pruc 1 VAR vawn odt et ......1 4 Purchase S Software/VW:ireBs :1 OW POS Descnntron,. Item Code I PricoLs Unit J rPer Auth Foe r 1 s 1 Merchant Owns Sottvraretiiireless I Qty I POS Description item Reprogram Fe CON Unit Pin Pad Enovption Mon Fee Per IMP I Per Au% Fee 1 Tender Retail Multi 1 0 r I 1 1 V.3.2.2.75 0 1 1 1 a t$ 1 Smote! Programs Qty 1 POS Descrtpbon item Code I Price per Unit I EqUiprnent Back from Merchant .1— 1 1 I Used a I AJI mt state and local taxes will be applied I 2 USBGOV 032009 file ://C: \temp \XPGrpWise \49DC9792tuk-mailIT-Post 10016F61311A13381 GWI 00001.H... 04/08/2009 Page 3 of 9 SE Ruth American Express: z, Fee ESA ❑One Point CAP p 3' Amex (10 digits) 0.15 Monthly Volume. 1.4. 0.ib ❑Amex Rate k Other ;i;' ..`'f CNP Downgrade 0.30 1 Other Flat Fee Option (ESA Only): 5.95 Other. JCB JCB R Rate- Debit Includes INLK ttntedink}, MSTO (Maestro), ACCL (Aaelf), AFFN, ALAS (Alaska), CU24, ITS (Shazam). NETS, NYCE, PULSE and StAR DCC Rebate °l Set Up Fee ❑Money Manager Vendor I `"Y Working Capital Vendor. I 1 MCP 9 Users Monthty Fee Set Up Type (check one( MID CM ENT Set Up Feo 0 ACS Remote ID Set Up Fee Monthly Fee Processing Options: POP (POS image) ARC (POS Image) SOC POS Image or Cash Office Image) I 1 ANNUAL Check volume: 2. Average check amount ..i 3. Maximum check amount 1 ECS Mosnht�Mmimum: Please check box for each additional service option Conversion with Guarantee 1 NSF Survive Fee Processing ,m S2 00 per NSF item. Guarantee Rate: Per TransacLt n: S Not applicable for POP Guarantee and all ARC products Conversion with Verification Collections EnOune Reporting Access: 1 Pei Transaction Per Return Transaction: users: n_. $29.95 each per month 5- Conversion Only Collections Tum off return memo advices Pot Transaction Per Return Transaction. Card Style Card Quantity Price ©Mcntts .cK fy pa" per month Basic (Includes transactions per beat on annually_ Additional transaction bided $0.29 per i ❑Standard transaction) Custom OR I Max Card Value (Default 9500) Transaction Pricing pet transaction and per month. V Plexi Stand (Kit 91) X Service Fess (Cardholder charged on unused balances) Posters (2) Buttons (10) (Kit #2) X Custom Cards are required Ca Lit Sadoos (2$i {K t #3) x Service Fee per Transaction 50.12 Apply same to all states? El Y N (rf no, cartploto for coop state) Card Carriers (enter total cards) Fee Amount: _F' M of Style t F Applied: 0 Monthly Quarterly 0 Annually of Style x Beginning: Months 9 of Style After: Act+vation Last Transaction Date (Multiples or 100 onty} Lock Balances After. _Months of non-use (default 72 months) 0 Monthly Online a Users -i' ;_t.v Q Graphic Deign Senuce VAR Manufacturer, Custom Card Upgrade S Rayon (Direct) VAR Software: •I'''.:, -7' ❑Gives(Indrect lir Misc. Fee i "i„ Version: raise Fee -r Card Style: Text Color. '.1 Justification: 0 Lea Center Right As submitted i Imprint Logo (To avoid delay, please submit artwork to: EGCArtworiot0Efa n.CQn OR I Q Text (Imprinting details MUST be entered below) I *Font (select ONE Arial i3'amda' .Sadie Times New Roman Text Case (select ONE): 0 Title Case UPPER CASE lower case As submitted I a USBGOV 032009 file: /C: \temp\XPGrp Wise\49DC9792tuk-mailIT-Post 10016F61311 AB3 81 \GW 00001.H... 04/08/2009 Page 2 of 9 :ae.+.�'"- f x� ;���Y.>>r x�__,ail m.4 r� ...s y,'p.t r 1 'c n� c F,z:. t;;: 15; Merchoot Represela0ans and Certifications. By signing belok the applkmsn merchant ('Mete snl err yott"i and ds ropresan1lo3(a) represent and warrant to b100ol Ira. iElsrora wade CACes at 7300 Cadman ifghway. Knoxville, TN 3((20. and U. S. 8900 NaOomi Assocra0(n CMolneer'), with offer at U. S. Bonoorp Center, 2300 NrttNat Mnheapols, MN beeiTt, fcdlactively,'wa' or 1 us') that Wag mtomm9bon (100010050 this mercha0Y .r,.r ..•n Merchant APpticaticeY) is rue and 0511(20(0 and properly IMecfs the Iwsuteb9 and financial tmdittm of Mlxch v*, and G) rho parsons signal° INS h @rchantApp(eticn are duty eniPormad to and Merchant to all pm/dions of tors Merchant Application and Iho A, Tha *serve by an aub,Mxad representation of Merchant on the Merchant t..,»,........ ot the ransmlssion of a T orooclion Receipt or errs/ evI2kn Transaction ea of a Trsaction to us, 'Oda be de Merchant's acceptance of ard agreement to the tams and eSDndikans m :n eta nrJ in Me Agrrxmerx inr:i+afrg, wsfxtut limnteciCrr, nine Mend Apptcaton and Coo harms el Service (IDS') m Mort.. Was not reusx ter nos. {tease concoct our wltrrrtea ch secede center- Notwithstanding nditg any such non-ramped the TO$. Merchant agrees Ns comply with Nut Agreement, and si app6 Wye CaLiWye rules, and 1001(etr.1e mldu2001 the rules and regtfanonx „4,!: of 1f 1a Payment Networks, and urXIerstands mat taava as °empty will result in terminate-Ft of precesang 5farsmes Caplailz d terms shall, unless defined in this Merchant Applvalicn, have the sane moaning ascribed to them in tea TOS. Marcum agoras to estahtsn and wan lain 5litictant ends In an account to accommodate all trans 11011 sit nnuong bur net tented to, C1.... ,..,..,s, reams, 02(251ments, tees, lines, pert1800 and any other geplante dew uld?r the Aoroovn!M Merchant authorizes us to crerlitdobit that acctrar 1 as necessary- in addtwn to the fees set loam tw Merchant Appir,.Mim. tee alt pay Elate. at Ow moon carom cotes for ucawM m'ru'aena nee (0 .g ddsAld90 changes), spacial processing relreirsng. a:di ram a swaps and research inputireg. but mat Iim1l 2 lo, rosaorch roqured 10 respond In any Whirl party or 54o59m .era subpoena tory or oonashmmt on your 98000t i Merchant o,nsoo ands that we may take any of the ibtloWCa9 manna if necessary to gored order/h s from Ananoal Inds' 800048(1.01 towns (11001101001 egoist-Mt a reserve axwnt; .mpg a Mowing limn a moon on the dollar amount of 54te9 sarwactie00 Wad we wst process rot Merchant, wheel may GO ehe11080Iron tune td ante wile w wdtxwl rmtr» to hl amore; ooryor r "t ul ssapond tine wooasemg of sarsaacaerr reoel(1 for 99 lone as 00Cessary to overt 9ata sl,sp60ns, un,a0Yal ilr omortsa.n achxty A; Merchant muss obtain obtain as Atxhava0wh Coda via eleoro100 termna(ar midst deuce berme corrptelirtg any trorwaol on, teem cot v +dordanos that ion AUTHORIZATION 000E tS NOT A GUARANTEE OF ACCEPIANCE OR PAYMENT OF ATRANSACTION RECEIPT OF AN AUTHORIZATION CODE DUES NOT WAN THAT MERCHANT 411911. NOt HECENE A CHARGEBACK FOR THAT TRANSACTION Merchant and tts repnsentalive(a) aul10oze us prior moor acceptance at this Merdsand Appkwlien and Tema trite to titre II wearier. 100000115110(00 history 0001 bac0Qo d of e Montreal and le cbuln u9Kat 10411010 OW reports na Merchant that eat ocnst1er rtetansay to rev 0w Imo armptanco and onnliru:n,vt W tea Mocha. A1peuehn t Merchant also station/ea any person or credit reportag agent vrl Ire e ull` :..,,..,._,.'l In 00514 tr those merit treadles and le furnish Mal ir1mnat0n to us IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT. To help ton Om_...,._.. right the funang of (11w aid motley Murdered aaewaes, Endear taw i 54 recedes all 1aroial institullo's to mhtann, miff, and record inkro l0Gfn tl91 klenta1as earn per9011 who opens an 2011000t this mans we w4i use for certain mfnmm er. a ifanndy1119 0 eulnaa ds to nlaw1019 ndentry you. f Mardian! hall& 0Cawwaedges arc agrees mat any intonation prodded m cbrmedtm warn try M0Cria11 App1clbnn and a9 emus relevant 11tamai;.n nnay be Supplied by us to cur atlihaac s. This Merchant Agaicoacn may be 19rors n ono or Mare cennterposat, orat K wlarn shall con ititute to od55n1 and 81 of 'Mach, taken tomato'. shah corstduta arm awl Um same WMrchxl Applicalinxn, Delivery of 0o ootod counterparts of lies Manama Amid-Rpm may 013 actxmPt red by a axon 98 tranamIssirxt and a signed facaimikl or copy of this Merchant Appdom t snail vinetaute a naiad original. i Mrauvacan Ceram. ;AC.sxy(A.IUT grp+STetpl By 6gnng below. I represent that I hove road any am au:u 18 sign and a:hmil the appatyaun to: the above entity wh 0(1035 to be bound by VB Alnencan Em 00010 Card Awepterro i (b•: ('AXP A,..,_..._..:'), and that sY vifwrtuumn prbritled Mc vs i3 Ws, corlellet& aM acwre:s. 1 eirtnonze Etahrx, area American Express Treed RNntrxi Sondes Crxnpary. In: l• an3 AXP's agents-and Mtvte9, as defined an the AXP Nytement, to testy VW information it lho app wit rproivn and exrhartgu Wattsaion about me personally, 00uri g try requ80ang reports trom 0onsumer .,...,,..,,anoraks and Made :sing such inkernalirktlu 11mu agent. 900003(118110410.01(0(1010100,12 Other pates for any purpose pernrttad by 00', iwdfmnz0 and direct Flamm AXP, AXP agents and AtfliO4ras re Wow me 101000ty, rr 11 gar erxty above, disports about rue Mai trey 0901 requested from cnrcimwr agea1es. Sun s1arrnats n will Include the clams and eddrau 01 Ma� the 8iercy 'mg Ito rrq,ori. e th 1 Woo au 001118 AXP io us e repots arum wrrswmrt repCtina ages o m es t orhol ry end adminlstlaav tpp.p.. I i r tma9r2trnd mat upon AXP"s approve! of ten amplieatiart tut entity wit be Ott a copy of Ma AM* Agreement a12 malanals welcoming 11, rather to AXP'0 program for Haven to perform selrdee for AXP ur AXP'S 515x. Want Card accepters program which has Milscant wrneing tams (8.9 111081 uu speeds of Par) t vderats ad mu d the entity des not 109812y terms Eidoon 001 :cog mot1am, wt taw slaty may bit ernrednd m American En¢resds staradmd Cards vxpiuxr pradr9rn, and Iha etd,ay U3rm'r the AXP Agreement, By .d ter American Express Clad for gee pvdla t (g1W. a:]AV aevvsxs. or anerw�e wlkasn9 ms W no ba,IM, m8 enutY 051006 m ty be m onnnd by nate the A7(P Mrroe, aevd j Merchant DSA Ni City of ukwila '11 Signature: X A l t ,i 1 Printed Name: Shawn Hunstock I Title: Finance Director Date: 4410 Oct Signature: Printed Name: Rhonda berry v t' I Tithe: City Administrator Date: i L .tip_ su To ale best of my anowl ga, t es trot the information gattad in 1hs Media. Appt was 910510ed by Me Merchant and rs true, rtnnotate and w.ctea10 t hurter croMy teal me s+9na089s were provided by the Merchants 1Aisd^ 10011 repr858ntet11. Sates Rep Signature: X Printed Name: Michael Hodge Rep ID 15778 Date: i Accepted by Elavon,Inc.. Date: Accepted by Member, Date: 4 USBGOV 032009 file: /C: \temp\XPGrpWise \49DC9792tuk mailIT -Post 10016F61311 AB3 81 \GW 00001.H... 04/08/2009