@ VERMONT SYSTEMS
SUB-MERCHANT APPLICATION AND AGREEMENT (SMAA)
SELECTION 1: SUB-MERCHANT INFORMATION
Business/ Sub-Merchant (provide legal entity name) Doing Business As ltf appllc:abl&):
City of Merced, CA City of Merced Comm Srvcs
Data of Formation Approx. Years In Business Buslnes Address 1889 100+ years 678 W 18th St. Merced, CA 95340
Tax ID fFEIN) Website (URL) Business Phone
94-60000371 www.cityofmerced.org (209 )388-7800
Primary Contact Name (For General Communications) Primary Contacts Phone Primary Contact Email Michelle Reid 209-385-6895 [email protected]
Public Individual Corporation Partnership Other
□ Sole OS-Corp □ General □ Non-Profit Business Type
(Select one} ✓
Private D Proprietorship DC-Corp □ Partnership (SOlC}
□
Dndividual □ LLC □ Limited l!!!iGovernment
□ Partnership □ Other:
Has this business processed credit cards
before?
Has this business ever been terminated from Will this business be What payment methods will the business accept? accepting credit cards from any network? running a presale prior to opening? [Z]Yes Yes (Z]No
Briefly describe the nature of the services provided by this business.
Adult and youth program that includes sports, leisure classes, facility rentals, park reservations, Zoo operations , and special community events
1 City of Merced Parks & Community Services
2 City of Merced Zoo
3 4
1 Merced Park&Rec
Location#:
1 2 Merced Park&Rec Web
Location#:
1 3 Merced Zoo
Location#:
2 4 Merced Zoo Web
Location#:
2 FILE NAME: SMAA PUBLIC
Template : Sub Merchant Application And Agreement
O ves ✓ No [Z]Debit IZ]credit DACH
What types of payment wou ld this business like to accept? !!! In Person !! Online !!Telephone !!Mail-in □ Recurring Billing as Sec.
l
address
632 W. 18th St. Merced, c.eii □ 209-385-6855
1045 W 25th St. Merced, C 209-725-3337
card present [Z]
web [Z]
card present [l]
web [Z]
1 ©RecTrac, LLCAII rights reserved.
Last Revision: 09/26/2023
SECTION 5: CONTROL 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. (1) "Control Owner" must be provided. A Control Owner is not required to have an ownership interest in the Sub-Merchant 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/AUTHORIZED CONTACT( MUST BEA NATURAL PERSON)• Denotes required fields for all applicants F'l]I Le2al Nam.e • Dat.e of Birth •
Kuljit Singh
Address (Home qr Business) •
678 W. 18th St. Merced, CA 95340 Deputy Finance Officer Phone (Home or Business) • Email*
209-385-6883 SinghK@cityofmerced .o'B
SECTION 6: BANKING I NFQRMATIQN (A copy of a voided check or a bank letter with full account details listed will be required).
For multiple bank accounts only: Include the associated MID number from Section 4! Account Name Routing Number MID# Ac~ountNumber
Wells Fargo Deposit Account 121 000248 Merced-Parks/Rec 4050019967 Wells Fargo Deposit Account 121000248 Merced Online Park/Rec 4050019967 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 underwriting 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; (SJ the Payment Facilitator's provision of payment services under the Sub-Merchant Agreement shall be expressly conditioned on Sub-Merchant's payment of aH fees and other charges, and its compliance with VS's Terms of Service and Privacy Policy, as may be revised from time to time.
AUTHORIZATION: Sub-Merchant expressly authorizes the Payment Facilitator identified below to take the following actions: (1) to establish a primary 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 purposes 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 affiliates 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 interests; (7) to withhold the remittance of any funds in accordance with lawful orders, garnishments and/or tax levies; (8) to recoup, retrieve or collect from any source of available funds, inc:luding 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 ru.n at the Sub-Merchant's place or places of business.
SUBMITTED AND AGREED TO BY:
(Sub-Merchc}ht) City of Merced
X
v- Name and Tttle
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Date
J lPPRpv ~'DAS TO F.DRM:
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Tom plate: Sub Merchant Application And Agreement
ACCEPTED BY:
Vermont Systems, Payment Facilitator
X
Name and Title
2 ©RecTrac, LLCAII rights reserved.
Last Revision: 09/26/2023
Date