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Home My WebLink AboutBluefin Merchant Application 2014 03 21 V c atca_) 59/ 6/ 33317 1050 Crown Pointe Parkway,Suite 720 Merchant Application Bluefin- Atlanta,GA 30338 Payment Systems 800-675-6573 Toll-Free 312-640-0294 Fax Sales Representative Phone 01. Business Information 1 of 3 Legal Business Name as it appears on your income tax return Federal Tax ID as it appears on your income [l I certify that I am a foreign entity/non- tax return resident alien.(If checked,please attach City of Central Point IRS Form W-8) NOTE:Failure to provide accurate information may result in a withholding of merchant funding per IRS regulations.(See Part III,Section A.4 of your Program Guide for further information.) Billing Address Doing Business As(DBA)Name 140 South Third Street City of Central Point Billing City Billing State Billing Zip Street Address(No P.O.Boxes) Central Point Oregon 97502 140 South Third Street Business Phone Fax Number City State Zip (541) 664-3321 Central Point Oregon 97502 Mobile Phone Customer Service Phone Website Address www.centralpointoregon.gov/ Contact Person(If different than owner) No.of Locations Years in Business E-mail Address Neuenschwander, Rachel 1 rachel.neuenschwander@centralpointoregon.gov 02. Merchant Profile 03.Visa®, MasterCard°& Discover°Information O Sole Proprietor 0 Partnership 0 Corporation 0 LLC 0 Non-Profit Merchant Type Card Swiped 0/0 ■Government Agency 0 Association/Estate/Trust 0 Political Committee • Goods or Services Sold i MCC State Incorporated O Retail p 0 Restaurant Manual Key w/Imprint License and Permits 1 toLodging Card Present w/Signature O/O Do you currently accept Visa,MasterCard Service .....-- d or If Yes,Processor Discover? O Yes • No 0 Mail&Phone Order Mail&Telephone Order O O O/O •eCommerce Has merchant or any principal filed for or been If Yes,Date subject to bankruptcy? 0 Yes ■No Internet$eCommerce O/O 04.Average Ticket&Monthly Volume Average MCNisa/Discover Ticket Sale Average MCNisa Monthly Volume Average Discover Monthly Volume Highest Ticket Amount 05.Additional Information Average Ticket&Monthly Volume Note: Each person certifies that the average ticket size and monthly volume indicated is accurate and agrees that any transaction or monthly volume that exceeds either of the Refund Policy %of Deposit Required amounts could result in delayed and/or withheld settlement of funds. ■All sales final 0 30 days 0 Exchange only Do you use any third party to store,transmit or If Yes,Name Premises 0 Retail Store 0 Office Building If Other process cardholder data? 0 Yes MI No 0 Shopping Center 0 Residence 0 Commercial Do you use software for storing,transmitting or If Yes,Name Previous Processor j Reason for Leaving Termination Date processing transactions? 0 Yes MI No Do you use any third party fulfillment? If Yes,Name Percent of Orders 7 Days 14 Days 30 Days 30+ 0 Yes I■No Delivered In 06. Owner 1 Ownership% 07.Owner 2 Ownership% Name ; Title Name Title Rachel Neuenschwander Home Address(No P.O.Boxes) Home Address(No P.O.Boxes) 140 South Third Street City ; State Zip City State Zip Central Point Oregon; 97502 Home Phone Number Social Security Number Home Phone Number Social Security Number 555-55-5555- Drivers License Number D.L.State Date of Birth Years at Residence Drivers License Number l D.L.State Date of Birth l Years at Residence 123456789 OR 1980-01-01 Bluefin Payment Systems is a registered ISO of Wells Fargo Bank,N.A. CP1611(ia)Revised:03/07/14 • 08. Service Fee Schedule 2 of 3 Accept ALL Visa°,MasterCard°&Discover°Transactions(Presumed,unless any selections below are checked) Discount Fees based on gross sales volume Visa Acceptance MasterCard Acceptance I Discover Acceptance ❑Accept Visa Credit transaction only 0 Accept MasterCard Credit transaction only 1 0 Accept Discover Credit transaction only 0 Accept Visa Non-PIN Debit transaction only ❑Accept MasterCard Non-PIN Debit transaction only 0 Accept Discover Non-PIN Debit transaction only See Section 1.9 of the Program Guide for details regarding limited acceptance. Pass Through I/C:Includes Dues&Assessments 0 PriceSimple* 0 SwipePlus** 0 SMAP*** 0 QuickSwipe Pass Through Rate 0.450 Visa,MasterCard&Discover CREDIT Visa,MasterCard&Discover DEBIT Qualified Discount Rate 0.000 % Qualified Discount Rate 0.000 % CREDIT Mid-Qualified Rate + 0.000 % DEBIT Mid-Qualified Rate + 0.000 % CREDIT Non-Qualified Rate + 0.000 % DEBIT Non-Qualified Rate + 0.000 Setup Fee $ 0.00 Mid&Non Qual Surcharge Gateway Setup Fee $ Annual Fee j $ 0.00 Monthly Statement Fee $ 9.95 'Note:Please see Part III,Section A.3 of the Program Guide for early termination fees. Monthly Minimum $ 0.0 Pin-Based Debit Transactions 0 Pass Through Network&Switch Fees Authorization Fee $ 0.30 per item PIN Debit Transaction Fee $ 0.00 per item Mid&Non Qual Authorization Surcharge Fee $ 0.00 per item Visa Settlement Network Access&Usage Fee $0.0195 per item Other Item Fee $ 0.00 per item MasterCard Settlement Network Access&Usage Fee $0.0195 per item Non-Bankcard Authorization Fee $ 0.30 per item Discover Settlement Network Access&Usage Fee $0.0075 per item Voice AVS/Authorization Fee $ 1.00 per item Pass ACQ ISA Fee? ■ Voice Response(IVRNRU)Fee $ 0.00 per item Pass Visa Misuse of Auth Fee •• Yes ❑No Batch Header Fee $ 0.00 per item Pass Visa Acquirer Processing Fee ■Yes 0 No AVS Surcharge $ 0.0 per item Pass Visa Zero Floor Limit Fee ■Yes 0 No Chargeback Fee $ 25.00 per item Pass Visa International Acquirer Fee ®Yes 0 No Retrieval Fee $ 15.00 per item Pass Visa Kilobyte Fee 0 Yes •No Return/NSF Fee $ 30.00 Pass Visa Transaction Integrity Fee ■Yes 0 No • PCI Compliance Fee"" $ 11.95 Pass Visa Fixed Acquirer Network Fee ■Yes 0 No Regulatory Product Bundle Monthly Fee $ 0.00 Pass MasterCard License Volume Fee 0 Yes ■No MICROS Transaction Fee $ 0.00 per item Pass MasterCard Processing Integrity Fee •Yes 0 No E-Merchant View Monthly Fee $ 0.00 Pass MasterCard Kilobyte Fee 0 Yes •No Internet Gateway Monthly Fee $ 0.00 Pass MasterCard Acquirer Support Fee ®Yes 0 No Internet Gateway Transaction Fee $ 0.00 per item Pass MasterCard Cross Border Fee •Yes 0 No ACH Discount Rate 0.450 % Pass MasterCard CVC2 Fee 0 Yes •No ACH Transaction Fee $ 0.30 per item Pass Discover International Processing Fee ■Yes ❑No Wireless Transaction Fee $ 0.00 Pass Discover International Service Fee •Yes 0 No Wireless Monthly Access Fee $ 0.00 per item Pass Discover Data Usage Charge •Yes 0 No PriceSimple Monthly Fee $ Pass Discover Network Authorization Fee 0 Yes •No SwipePlus Monthly Fee $ TIN/TFN Invalid $ 0.00 monthly QuickSwipe Monthly Fee $ 'Non-swiped transactions are assessed at 2.79%+$0.25.A charge of 0.25%will be added to Premium and Reward credit card transactions because of the higher cost of processing these cards through Visa,MasterCard and Discover.Fees for international transactions done through MasterCard,Visa and Discover will be added to the transaction amount.Charge-back and retrieval fees are still applied at the fee defined in your merchant processing agreement.PriceSimple pricing is for Visa,MasterCard and Discover transactions only and does not include American Express transactions.ACH transactions are not included in this pricing grid."Non-swiped transactions are assessed at 3.29%+$0.35.A charge of 0.25%will be added to Premium and Reward credit card transactions because of the higher cost of processing these cards through Visa,MasterCard and Discover.Fees for international transactions done through MasterCard,Visa and Discover will be added to the transaction amount.Charge- back and retrieval fees are still applied at the fee defined in your merchant processing agreement.SwipePlus pricing is for Visa,MasterCard and Discover transactions only and does not include American Express transactions.ACH transactions are not included in this pricing."'Processed funds will initially be held for 30 days.On day 31,you will receive next-day funding of processed transactions.A charge of 0.25%will be added to Premium and Reward credit card transactions because of the higher cost of processing these cards through Visa and MasterCard.Fees for international transactions done through MasterCard and Visa will be added to the transaction amount.Charge-back and retrieval fees are still applied at the fee that will be defined in your merchant processing agreement.SMAP pricing is for bank card only.ACH transactions are not Included in this pricing grid. "Merchants will be charged$19.95 until they have completed their PCI compliance requirement. The monthly PCI Compliance Fee will be lowered to the amount indicated above in Service Fee Schedule section of your merchant agreement. If merchant completes their PCI Requirements through a Third Party Qualified Security Assessor(QSA)then the PCI Compliance fee will be waived.For further information please visit www.bluefin.com/pci-compliance/faq. 09.American Express°Acceptance Enter Existing MID Numbers on Deployment Form Do you wish to apply for an American Express merchant account? 0 Yes •No Existing American Express Merchant Account American Express Discount Rate" % American Express Flat Per Transaction Fee $ American Express Prepaid Discount Rate % American Express Flat Per Transaction Fee $ American Express Monthly Fee'0 ! $7.95 American Express ESA/Pass Through' ❑ 'American Express Monthly Flat Fee or Discount Rate may apply. Bluefin Payment Systems is a registered ISO of Wells Fargo Bank,N.A. CP1611(ia)Revised:03/07/14 CP1611(ia) PART I: CONFIRMATION PAGE PROCESSOR Name: Bluefin Payment Systems INFORMATION: Address: 1050 Crown Point Parkway,Suite 720,Atlanta,GA 30338 URL: Customer Service#: 1-800-675-6573 Please read the Program Guide in its entirety.It describes the terms under which we will provide merchant processing Services to you. From time to time you may have questions regarding the contents of your Agreement with Bank and/or Processor.The following information summarizes portions of your Agreement in order to assist you in answering some of the questions we are most commonly asked. I. Your Discount Rates are assessed on transactions that qualify for certain 6. We have assumed certain risks by agreeing to provide you with Card reduced interchange rates imposed by MasterCard,Visa and Discover.Any processing or check services.Accordingly,we may take certain actions to transactions that fail to qualify for these reduced rates will he charged an mitigate our risk,including termination of the Agreement,and/or hold - additional fee(see Section 18 of the Program Guide). monies otherwise payable to you(see Card Processing General Terms in 2. We may debit your bank account(also referred to as your Settlement Section 23, Term;Events of Default and Section 24,Reserve Account; Account)from time to time for amounts owed to us under the Agreement. Security Interest),under certain circumstances. 3. There are many reasons why a Chargeback may occur. When they 7. By executing this Agreement with us you are authorizing us and our occur we will debit your settlement funds or Settlement Account.For a more Affiliates to obtain financial and credit information regarding your busi- detailed discussion regarding Chargebacks see Section 10 of Card Process- ness and the signers and guarantors of the Agreement until all your tug Operating Guide. obligations to us and our Affiliates are satisfied. 4. If you dispute any charge or funding,you must notify us within 60 clays 8. The Agreement contains a provision that in the event you terminate of the date of the statement where the charge or funding appears for Card the Agreement early,you will be responsible for the payment of an early Processing. termination fee as set forth in Part III,A.3 under"Additional Fee Infor- mation." 5. The Agreement limits our liability to you. For a detailed description of the limitation of liability see Section 20 of the Card Processing General Terms. 9. Card Organization Disclosure Visa and MasterCard Member Bank Information:Wells Fargo Bank N.A. The Bank's mailing address is 1200 Montego,Walnut Creek,CA 94598,and its phone number is(925)746-4143. Important Member Bank Responsibilities: Important Merchant Responsibilities: a) The Bank is the only entity approved to extend acceptance of Card a) Ensure compliance with Cardholder data security and storage requirements. Organization products directly to a Merchant. b) Maintain fraud and Chargebacks below Card Organization thresholds. b) The Bank must he a principal(signer) to the Merchant Agreement. c) Review and understand the terms of the.Merchant Agreement. c) The Bank is responsible for educating Merchants on pertinent Visa d) Comply with Card Organization rules. and MasterCard rules with which Merchants must comply;but this e) Retain a signed copy of this Disclosure Page. information may be provided to you by Processor. d) The Bank is responsible for and must provide settlement funds to f) You may download"Visa Regulations"from Visa's website at: the Merchant. http://usa.visa.conr/merchants/operations/op_regulations.htnrl e) The Bank is responsible for all funds held in reserve that are g) You may download"MasterCard Regulations"from MasterCard's website at: derived from settlement. http://www.mastercard.corn/us/merchant/support/rules.html Print Client's Business Legal Name: City of Central Point By its signature below,Client acknowledges that it has received the complete Program Guide [version CPI 61 I(ia)] consisting of 32 pages (including this confirmation). Client further acknowledges reading and agreeing to all terms in the Program Guide,which shall be incorporated into Client's Agreement. Upon receipt of a signed facsimile or original of this Confirmation Page by us,Client's Application will be processed. NO ALTERATIONS OR STRIKE-OUTS TO THE AGREEMENT WILL BE ACCEPTED. Client's Business Principal: Signature(Please sign below): Accounting Specialist Title Date Rachel Neuenschwand Please Print Name of Signer CP1611(ia) 10. Bank Information 3 of 3 Name on Checking Account Bank Name Bank Address Account Number ABA/Transit Number City State Zip 11. Sales Representative Information I hereby certify that I have inspected the business premises as described herein.I further represent and warrant that the Information set forth in this Application is true,complete and not misleading in any way and that inventory/services are consistent in type,quantity and quality with this Application.I have confirmed the identity of the individual signing this document.The Merchant appears to be conducting business as represented and I am not in possession of any knowledge to the contrary. Sales Representative Signature Sales Representative Name Date 12.Acknowledgement&Agreement Client certifies that all information set forth in this completed Merchant Processing Application is true and correct and that Client has received a copy of the Program Guide(Version CP1611(ia)and Confirmation Page,which is part of this Merchant Processing Application,and by this reference incorporated herein.Client acknowledges and agrees that we,our Affiliates and our third party subcontractors and/or agents may use automatic telephone dialing systems to contact Client at the telephone number(s)Client has provided in this Merchant Processing Application and/or may leave a detailed voice message in the event that Client is unable to be reached,even if the number provided is a cellular or wireless number or if Client has previously registered on a Do Not Call list or requested not to be contacted Client for solicitation purposes.Client hereby consents to receiving commercial electronic mail messages from us,our Affiliates and our third party subcontractors and/or agents from time to time.Client further agrees that Client will not accept more than 20%of its card transactions via mail,telephone or Internet order.However,if your Application is approved based upon contrary information stated in Section 3,Visa,Mastercard and Discover Information section above,you are authorized to accept transactions in accordance with the percentages indicated in that section. By signing below,each of the undersigned authorizes us,our Affiliates and our third party subcontractors and/or agents to verify the information contained in this Application and to request and obtain from any consumer reporting agency and other sources,including bank references,personal and business consumer reports and other information and to disclose such information amongst each other for any purpose permitted by law.11 the Application is approved,each of the undersigned also authorizes us,our Affiliates and our third party subcontractors and/or agents to obtain subsequent consumer reports and other information from other sources,including bank references,in connection with the review,maintenance,updating,renewal or extension of the Agreement or for any other purpose permitted by law and disclose such information amongst each other.Each of the undersigned furthermore agrees that all references,including banks and consumer reporting agencies,may release any and all personal and business credit financial information to us,our Affiliates and our third party subcontractors and/or agents.Each of the undersigned authorizes us,our Affiliates and our third party subcontractors and/or agents to provide amongst each other the information contained in this Merchant Processing Application and Agreement and any information received subsequent thereto from all references.including banks and consumer reporting agencies for any purpose permitted by law,It is our policy to obtain certain information in order to verify your identity while processing your account application. As part of our approval,processing services,continuing fraud prevention and account review processes,the undersigned consents to the use of information gathered online or that you submit to us,and/or automated electronic computer security screening,by us or our third party vendors. By signing below,I represent that I have read and am authorized to sign and submit this application for the above entity,which agrees to be bound by the American Express®Card Acceptance Agreement ("Agreement"),and that all information provided herein is true,complete,and accurate.I authorize Bluefin Payment Systems("Bluefin")and American Express Travel Related Services Company,Inc.("American Express")and American Express's agents and Affiliates to verify the information in this application and receive and exchange information about me personally,including by requesting reports from consumer reporting agencies from time to time,and disclose such information to their agent,subcontractors,Affiliates and other parties for any purpose permitted by law.I authorize and direct Bluefin and American Express and American Express's agents and Affiliates to inform me directly,or inform the entity above,about the contents of reports about me that they have requested from consumer reporting agencies.Such information will include the name and address of the agency furnishing the report.I also authorize American Express to use the reports on me from consumer reporting agencies for marketing and administrative purposes.I am able to read and understand the English language.Please read the American Express Privacy Statement at http://www.americanexpress.com/privacy to learn more about how American Express protects your privacy and how American Express uses your information.I understand that I may opt out of marketing communications by visiting this website or contacting American Express at 1-(800)-528-5200.I understand that upon American Express's approval of the application,the entity will be provided with the Agreement and materials welcoming it to American Express's Card acceptance program. "0.30%downgrade will be charged by American Express for transactions whenever a CNP or Card Not Present Charge occurs including Prepaid Cards.CNP means a Charge for which the Card is not presented at the point of purchase(e.g.,Charges by mail,telephone,fax or the Internet).NOTE:The CNP Fee is applicable to transactions made on all American Express Cards,including Prepaid Cards for Retail,Restaurant,and Travel Agencies/Tour Operators key-entered programs.(Note:This fee applies to both OnePoint and ESA.) An Inbound fee of.40%will be applied to any charge made using a card,including Prepaid Cards,issued by an issuer located outside of the United States(the United States does not include Puerto Rico,the U.S. Virgin Islands and other U.S.territories and possessions)except MCC 7032,8211,8351,and 8220 card transactions.(Note:This fee applies to both OnePoint and ESA.) Client authorizes Bluefin and Bank and their affiliates to debit Client's designated bank account via Automated Clearing House(ACH)for costs associated with equipment hardware,software and shipping.You further acknowledge and agree that you will not use your merchant account and/or the Services for illegal transactions,for example,those prohibited by the Unlawful Internet Gambling Enforcement Act,31U.S.C.Section 5361 et seq,as may be amended from time to time,or processing and acceptance of transactions in certain jurisdictions pursuant to 31 CFR Part 500 et seq.and other laws enforced by the Office of Foreign Assets Control(OFAC). Client certifies,under penalties of perjury,that the federal taxpayer identification number and corresponding filing name provided herein are correct.Client agrees to all the terms of this Merchant Processing Application and Agreement.This Merchant Processing Application and Agreement shall not take effect until Client has been approved and this Agreement has been accepted by Bluefin and Bank. Signature No.1 i Title Date Signature No.2 Tale , Date F. 13. Personal Guaranty Personal Guarantee:In exchange for Bluefin Payment Systems,Wells Fargo Bank,N.A.,and 'nent,and/or the American Express Card Acceptance Agreement,the undersigned unconditionally and irrevocably guarar 3reements,as applicable, as they now exist or as modified from time to time,whether before or after termination orexpir f any amendment of such agreements.The undersigned waives notice of default by Client and agrees to indemnify the I cements.The Guaranteed Parties shall not be required to first proceed against Client to enforce any remedy before proc t be discharged or affected for any reason.The undersigned understands that this is a Personal Guaranty of payment an; iaranty in entering into the foregoing agreements,as applicable. Signature No.1 >ate Signature No.2 Date Bluefin Payment Systems 1050 Crown Pointe Parkway,Suite 720 Altanta,GA 30338 Approved/Accepted By: Date Date Bluefin Payment Systems is a registered ISO of Wells Fargo Bank,N.A. CP1611(ia)Revised:03/07/14