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(Internal Use Only) <br /> Point&Pag Client Application Partner Code: <br /> Partner Hierarchy: ❑This is a Super Partner ❑This is a Sub-Partner. SP Name and Code are: <br /> Account Representative: Patty Melton Submission Date: 8/2/2013 <br /> Card Readers: Quantity: 5 Target Live Date: 10/15/2013 <br /> Price per Reader:$ Contract terms: 1 year <br /> Client Legal Name as filed with the IRS: Federal Tax ID: <br /> ORANGE COUNTY GOVERNMENT <br /> DBA: ORANGE COUNTY TAX ADMINISTRATION <br /> Address: PO BOX 8181 <br /> City: HILLSBOROUGH State: NC <br /> Phone#to display in <br /> Zip: 27278-8181 Customer Receipts: 919-245-2725 <br /> Website Address: www.orangecountync.gov/revenue <br /> Primary Contact Name: Primary Phone#: Primary Email: <br /> Dwane Brinson, Director 919-245-2726 dbrinson@orangecountync.gov <br /> Technical Contact: Technical Phone#: Technical Email: <br /> Hank Derby, Systems Anal 919-245-2111 wderby@orangecountync.gov <br /> Accounting Contact: Accounting Phone#: Accounting Email: <br /> Katie Jones, Rev Tech 919-245-2729 kaiones oran ecount nc. ov <br /> Customer Service Contact: Customer Service Phone: Customer Service Email: <br /> Nancy Freeman, Office Man 919-245-2735 nfreeman@orangecountync.gov <br /> The undersigned agrees to abide by the Terms and Conditions of the Global Merchant Services Agreement,viewable at www.pointandpay.com/agreement <br /> Orange County Tax Administrator <br /> Si e Title <br /> Dwane Brinson 8/2/2013 <br /> Name (Print) Date <br />