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<br /> <br /> <br /> <br />1 <br />1 <br />Template: CNT-VS-QM-SA Sub Merchant Application and Agreement 09NOV2020-V01 ©RecTrac, LLC All rights reserved. <br />File Name: CNT-VS-QM-SA Sub Merchant Application and Agreement 19OCT2022-V03 Last Revision: 10/20/2022 <br />SUB-MERCHANT APPLICATION AND AGREEMENT (SMAA) <br /> <br />SECTION 1: SUB-MERCHANT INFORMATION <br />Business / Sub-Merchant (provide legal entity name) Doing Business As (if applicable) <br /> <br /> <br /> <br />Date of Formation Approx. Years in Business Business Address <br /> <br /> <br /> <br />Tax ID (FEIN) Website (URL) Business Phone <br /> <br /> <br /> <br />Primary Contact Name (for general communications) Primary Contact Phone Primary Contact Email <br /> <br /> <br /> <br /> <br /> <br /> <br />Business Type <br /> <br />(Select One) <br /> <br /> <br /> <br />PUBLIC <br /> <br />☐ <br /> <br /> <br /> INDIVIDUAL CORPORATION PARTNERSHIP OTHER <br /> <br /> ☐ Sole Proprietorship ☐ S-Corp. ☐ General Partnership ☐ Non-Profit (501C) <br /> <br /> ☐ Individual ☐ C-Corp. ☐ Limited Partnership ☐ Government <br /> <br /> ☐ LLC ☐ Other: <br /> <br /> <br />PRIVATE <br />☐ <br />Has this business processed credit <br />cards before? <br />Has this business ever been terminated from <br />accepting credit cards from any network? <br />Will this business be <br />running a presale prior to opening? <br />What payment methods <br />will the business accept? <br /> <br />☐ Yes ☐ No <br /> <br />☐ Yes ☐ No <br /> <br /> <br />☐ Yes ☐ No ☐ NA <br /> <br />☐ Debit ☐ Credit ☐ ACH <br />Briefly describe the nature of the services provided by this business? What types of payment would this business like to accept? <br /> <br />☐ In-Person ☐ Online ☐ Telephone ☐ Mail-In ☐ Recurring Billing <br />SECTION 2: TRANSACTION INFORMATION (all financial assumptions approximated in USD) <br />Annual Card Volume ($) Avg Ticket (Card) ($) Max Ticket (Card) ($) Annual ACH Volume ($) Avg Ticket (ACH) ($) Max. Ticket (ACH) ($) <br /> <br /> <br />Total Annual Sales – All Transactions ($) <br /> <br /> <br />SECTION 3: LOCATION INFORMATION (use additional pages if necessary) <br /> Location/Business Name Business Address Same as <br />Section 1 <br />Business Phone <br />1 ☐ <br />2 ☐ <br />3 ☐ <br />4 ☐ <br />5 ☐ <br />6 ☐ <br />SECTION 4: MERCHANT ID INFORMATION (use additional pages if necessary) <br /> Merchant ID Account Name (will appear on statement) Associated Section 3 Location or Address <br /> <br />Card <br />Present <br /> <br />Web <br /> <br />Billing <br />Service <br />Fees <br />Annual Card Revenue <br />1 Location #: ______ ☐ ☐ ☐ ☐ <br />2 Location #: ______ ☐ ☐ ☐ ☐ <br />3 Location #: ______ ☐ ☐ ☐ ☐ <br />4 Location #: ______ ☐ ☐ ☐ ☐ <br />5 Location #: ______ ☐ ☐ ☐ ☐ <br />6 Location #: ______ ☐ ☐ ☐ ☐ <br />1, 2, 3, 4 <br />8,000 <br />40,000 <br />10,000 <br />10,000 <br />X <br />X <br />4ASSET MANAGEMENT <br />1 <br />3 <br />2 <br />X <br />X <br />PARKS & REC <br />SEYMOUR <br />PASSMORE <br />919-245-2015103 MEADOWLANDS DR., HILLSBOROUGH, NC 27278 <br />2551 HOMESTEAD RD, CHAPEL HILL, NC 27516 919-968-2070 <br />919-245-2625600 HWY 86 N, HILLSBOROUGH, NC 27278ASSET MANAGEMENT SVCS <br />SEYMOUR CENTER <br />PASSMORE CENTER <br />coffenburg@orangecountync.gov <br />50,000XOC WEBTRAC <br />919-245-2510 300 WEST TRYON ST. HILLSBOROUGH, NC 27278OC RECREATION <br />355.0056.00118,000 <br />Recreational activities, room reservations <br />x x <br />x <br />x xx <br />x <br />x <br />ORANGECOUNTYNC.GOV56-6000327 <br />CHAZ OFFENBURG 919-245-2450 <br />919-245-2453 <br />300 W EST TRYON STREET HILLSBOROUGH, NC 272782621752 <br />ORANGE COUNTY <br />DocuSign Envelope ID: 028D978E-DF71-4D79-863D-8360D7144DD8