2023-041-E-IT Dept-RecTrac-Parks and Rec

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2 Template: CNT-VS-QM-SA Sub Merchant Application and Agreement 09NOV2020-V01 ©RecTrac, LLC All rights reserved. File Name: CNT-VS-QM-SA Sub Merchant Application and Agreement 19OCT2022-V03 Last Revision: 10/20/2022 SECTION 5: OWNER INFORMATION Why Do We Need This Information? We require certain information about your ownership for compliance with federal Know-Your-Customer (or “KYC”) regulations promulgated by the Financial Crimes Enforcement Network Bureau of the U.S. Department of Treasury. KYC regulations seek to prevent financial crimes and the funding of terrorism, among other things. The information sought below is required by KYC regulations. Information about Beneficial Owners must be provided for any person or entity with a 25% or more ownership interest in the Sub-Merchant unless the Sub-Merchant is a Government Entity. Beneficial Owners may be natural persons (with Social Security Numbers) or they may be another legal entity (with a federal tax ID number). In addition to Beneficial Owner information, at least one (1) “Control Owner” must be provided. A Control Owner is not required to have an ownership interest in the Sub-Merchant (although they often do), and the Control Owner must be a natural person with significant responsibility to control, manage or direct the activities of the Sub-Merchant’s business. Control Owners often have the title of CEO, CFO, COO, Managing Member, General Partner, President or Treasurer. CONTROL OWNER (MUST BE A NATURAL PERSON; required fields for all applicants denoted with *; SSN and Driver’s License information only required for non-government entity) Full Legal Name * Social Security Number Date of Birth * Address (Home or Business) * Title Driver’s License State Driver’s License Number Phone (Home or Business) * Email * BENEFICIAL OWNER(S) (may be a natural person or legal entity; SSN and/or FEIN required; Beneficial Owner(s) information required for non-government entity) BENEFICIAL OWNER 1 Full Legal Name (Owner 1) SSN or FEIN Date of Birth / Date of Incorporation Address (Home or Business) Email Driver’s License State Driver’s License Number Phone Ownership Interest % BENEFICIAL OWNER 2 Full Legal Name (Owner 2) SSN or FEIN Date of Birth / Date of Incorporation Address (Home or Business) Email Driver’s License State Driver’s License Number Phone Ownership Interest % SECTION 6: BANKING INFORMATION (copy of a voided check or a bank letter with full account details listed will be required) Bank Name Account Name Routing Number Account Number ACKNOWLEDGEMENT: By signing below, Sub-Merchant expressly acknowledges that: (1) the individual signing this Sub-Merchant Agreement has the proper legal authority to bind the Sub-Merchant; (2) the Sub-Merchant’s Application for payment services may be rejected in underwrit ing but, once accepted, will constitute a legally binding Sub -Merchant Agreement with the Payment Facilitator identified below; (3) all information provided herein is true and accurate to the best of Sub -Merchant’s knowledge; (4) the Payment Service Terms and Conditions, and any other documents referenced as being part of the agreement, shall become part of this Sub-Merchant Agreement; (5) the Payment Facilitator’s provision of payment services under the Sub-Merchant Agreement shall be expressly conditioned on Sub-Merchant’s payment of all fees and other charges, and its compliance with VS’s Terms of Service and Privacy Policy, as may be revised from time to time; and (6) the authority granted herein shall be in the nature of a Power of Attorney, which shall be deemed created, is irrevocable and coupled with an interest. AUTHORIZATION: Sub-Merchant expressly authorizes the Payment Facilitator identified below to take the following actions: (1) to establish a prim ary merchant account with a payment processor of the Payment Facilitator’s choosing; (2) to access Customer Data, including but not limited to Cardholder Data, for the purpos es of providing the payment services contemplated by the Agreement; (3) to execute documents on Sub-Merchant’s behalf, or to take any other action which the Payment Facilitator deems reasonably necessary to provide its payment services to Sub -Merchant as described herein; (4) to access Sub-Merchant’s designated account(s) for purposes of received and accepting payments on settled transactions, together with any adjustments made on Sub - Merchant’s behalf; (5) to collect any Fees or other charges owed to Payment Facilitator, or any of Payment Facilitator’s aff iliates or subsidiaries, directly from the Sub-Merchant’s EFT/ACH draft; (6) to set up a reserve account where Payment Facilitator considers it reasonably necessary to protect its legitimate business in terests; (7) to withhold the remittance of any funds in accordance with lawful orders, garnishments and/or tax levies; (8) to rec oup, retrieve or collect from any source of available funds, including but not limited to the Sub -Merchant’s EFT/ACH draft, any Payment Facilitator expenditures related to Sub-Merchant’s eCheck returns, chargebacks, negative accruals or overdrawn accounts; and (9) to transfer billed amounts to an account held by Payment Facilitator to facilitate the settling of transactions run at the Sub -Merchant’s place or places of business. SUBMITTED AND AGREED TO BY: Sub-Merchant ACCEPTED BY: Vermont Systems, Payment Facilitator X X Name Date Name Date ORANGE COUNTY GENERAL 061000104 401036167Truist 300 West Tryon St. Hillsborough NC 27278 N/AN/A 919-245-2453 gdonaldson@orangecountync.gov CFO 12/25/1963N/AGary Donaldson Gary Donaldson Digitally signed by Gary Donaldson Date: 2023.01.05 11:16:25 -05'00' Gary Donaldson Digitally signed by Gary Donaldson Date: 2023.01.05 11:16:49 -05'00' DocuSign Envelope ID: 028D978E-DF71-4D79-863D-8360D7144DD8