DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC

Tao's Acupuncture

Tao He Owner 12/29/2015

Charles Calamia Sales Rep. 12/29/2015

DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC
OmahaWF1804 M E R C H A N T P R O C E S S I N G A P P L I C AT I O N A N D AG R E E M E N T OmahaWF1807(ia)

Phoenix AZ
Sales Office ____________________________________ Charles Calamia
Print Sales Rep Name _________________________________________________ Sales ID # ________________________________

Merchant Number _______________________________ Sales Rep. Signature __________________________________________________ Phone #: ________________________________

1. B U S I N E S S I N F O R M AT I O N Page 1 of 4
Clients Business Name (Doing Business As): Clients Corporate / Legal Name (Use Also For Headquarters Information):

Taos Acupuncture
Business Address: Billing Address (If Different Than Location Address):
4149 Woodrush Lane
City: State: Zip: City: State: Zip:
Comstack MI 49321
Location Phone #: Location Fax #: Contact Name:
616 540 6072
Business E-mail Address: Contact Fax # / E-mail Address:
taoacu2000@yahoo.com
Business Website Address: Contact Phone #:

Customer Service Phone #: Customer Service E-mail Address: Send Retrieval Requests to: Business Location Corp/Legal Location
Send Merchant Monthly Statement to: Business Location Corp/Legal Location
INDIVIDUAL / SOLE PROPRIETORSHIP: State in which Certificate of TAX EXEMPT ORGANIZATION (501C) State: ________ GOVERNMENT (Federal, State, Local)
Tao He
Assumed Name Filed: _____________________________ MI
State: _______ INTERNATIONAL ORGANIZATION
LIMITED LIABILITY
CORPORATION CHAPTER S, C State: _______ Location Filed: ________________ COMPANY State Filed: ________

MEDICAL OR LEGAL CORPORATION State: _______ ASSOCIATION / ESTATE / TRUST State Filed: ________ PARTNERSHIP State Filed: ________
Name (as it appears on your income tax return) FEDERAL TAX ID # I certify that I am a foreign entity /nonresident alien.
(as it appears on your income tax return) (If checked, please attach IRS Form W-8.)
Tao He 405 47 6807
NOTE: Failure to provide accurate information may result in a withholding of merchant funding per IRS regulations. (See Part IV, Section A.4 of your Program Guide for further information.)

*SIC / MCC: IATA/ARC: (MCC 4722 Only)

Note: *If your business is classified as High Risk and assigned (or is later assigned based upon your business activity) any of the following Merchant Category Codes (MCC): 5966, 5967 and 78411,
then registration is required with Visa and/or MasterCard within 30 days from when your account becomes active. An Annual Registration Fee of $500 may apply for Visa and/or MasterCard (total registration fees
could be $1,000.00). Failure to register could result in fines in excess of $10,000.00 for violating Visa and/or MasterCard regulations2.
1Registration for MCC 7841 is only required for non-face-to-face adult content.
2 Information herein, including applicable MCCs, is subject to change.

Detailed Explanation of Type of Merchandise, Products or Services Sold:

Acupuncture
2 . A D D I T I O N A L C R E D I T / S I T E S U RV E Y I N F O R M AT I O N A L L M E R C H A N T S
1. Zone: Business District Industrial Residential 14. Advertising Method (Attach at least one):
Catalog Brochure Direct Mail TV/Radio
2. Location: Mall Office Home Shopping Area Internet Phone Newspaper /Journals Other
Apartment Isolated Door-to-Door Marketing Materials required for Mail Order, B to B, Internet over
Flea Market Other $1 Million in annual volume. Attach Web Page for Internet Merchant.

3. How many employees: ____________ 15. Previous Processor: ______________________________________________________________

4. How many registers / Terminals: ____________ 16. Check Reason For Leaving: Rate Service Terminated Other:__________________

5. Is proper license visible? Yes Mail / Telephone Order / Business to Business / Internet Information
(All Questions must be Answered)
No, explain: _____________________________________________
1. What % of total sales represent business to business (vs business to consumer):
6. Where is the merchant name displayed at the site?
Business to Business ______% + Business to Consumer ______% = 100% (total sales)
Window Door Store Front
2. What % of bankcard sales represent business to business (vs business to consumer):
7. Merchant Occupies: Ground Floor Other: __________________ Business to Business ______% + Business to Consumer ______% = 100% (total sales)
8. # of Floors/Levels: 1 2-4 5-10 11+ 3. What is the time frame from transaction to delivery? (% of orders delivered in):
9. Remaining Floor(s) Occupied by: 0-7 days______% + 8-14 days______% + 15-30 days______% + over 30 days______% = 100%
Residential Commercial Combination None 4. MC / Visa / Discover Network /American Express sales are deposited (check one):
Date of order Date of delivery Other (specify) : ________________________________
10. Approximate Square Footage:
5. Who performs product / service fulfillment? Direct Vendor Other If vendor, add
0-250 251-500 501-2,000 2,001 plus
Name: __________________________________________________________________________
11. Are customers required to leave a deposit?
Address: ________________________________________________________________________
No Yes If Yes, % of deposit required: _______%
City : _____________________ State : ______ Zip: _______________ Phone: ________________
12. Return Policy: Full Refund Exchange Only None
Please describe how the transaction works, from order taking to merchant fulfillment
13. Do you have a refund policy for (attach additional sheet if necessary) :
MC / Visa / Discover Network / American Express Sales? ___________________________________________________________________________________
Yes No If yes, check one: Exchange Store Credit ___________________________________________________________________________________
MC / V/ Discover Network / American Express Credit.
___________________________________________________________________________________
If MC / V/ Discover Network / American Express Credit,
____________________________________________________________________________________
within how many days do you submit credit transactions?
0-3 4-7 8-14 Over 14 6. Does any of your cardholder billing involve automatic renewals or
recurring transactions (i.e., cardholder authorizes initial sale only)? Yes No

Merchant Initials: ________

Bank Copy - White Sales Representative Copy - Yellow Merchant Copy - Pink
DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC
Tao's Acupuncture
DBA Name: _________________________________________________________________________ Merchant #: _____________________________________ Page 2 of 4

OmahaWF1804 3 . C O M PA N Y H I S TO RY OmahaWF1807(ia)

Date Business Started: ________________________ Prior Bankruptcies? No Yes Business and / or Personal
4 . OW N E R S / PA RT N E R S / O F F I C E R S
OWNER / PARTNER / OFFICER 1 OWNER / PARTNER / OFFICER 2
Name: (First, MI, Last) % Ownership: Name: (First, MI, Last) % Ownership:
Tao He 51
Title: Owner Title:

Home Address: (No P.O. Box) 4149 Woodrush Lane Home Address: (No P.O. Box)

City: Comstack State: MI Zip: 49321 Country: usa City: State: Zip: Country:

Telephone #: 616-540-6072 Social Security #: 405-47-6807 Telephone #: Social Security #:

D.O.B.: 03/06/1954 DL #: State: D.O.B.: DL #: State:

5 . S E T T L E M E N T I N F O R M AT I O N

Deposit Bank: Bank Contact:

Transit / ABA #: Deposit Account #:

ACH Detail Flag: Individual Combined Separate (defaults to Combined if option not selected)
6 . E Q U I P M E N T / T H I R D PA RT Y I N F O R M AT I O N
Network (Front End): Omaha North Nashville Buypass
Do you use any third party to store, process or transmit cardholder data? Yes No
If yes, identify the Third Party Processor used: 00 None 01 Yahoo 02 Authorize.net 03 Cybersource 04 Verifone 05 Merchant Link 06 Shift 4
07 Apriva 08 FIS 09 Six Payment Services Corp 10 Verisign 99 Other (please specify) ___________________
INTERNET GATEWAY: First Data Global Gateway Other: _________________________________________________________________________________________
Wireless Network: __________________________________________________________________________________________________________________________________
PC / Internet Software __________________________________________________________ Quantity _______________ New Rent Lease Existing
Clover Go
Terminal Model _______________________________________________________________ 1
Quantity _______________ New Rent Lease Existing
Printer Model ________________________________________________________________ Quantity _______________ New Rent Lease Existing
PIN Pad _____________________________________________________________________ Quantity _______________ New Rent Lease Existing

LEASE COMPANY: (04) First Data Global Leasing Lease Term: ______
48 Mos. Annual Tax Handling Fee: 10.20
Total Monthly Lease Charge: $ _____________ w/o taxes, late fees, or other charges that may apply See Lease Agreement in Program Guide for details.
This is a non-cancelable lease for the full term indicated.)
Address City State Zip Attention:
4149 Woodrush Lane Comstack MI 49321 Tao He
7 . G R I D I N F O R M AT I O N I N T E R N A L U S E O N LY
AUTHORIZATION GRID ID#: _________________________ USER DEFINED GRID ID#: _________________________ MFC GRID ID: _________________________ 8-pos. Alpha/Numeric

MC CREDIT ___________________ VISA CREDIT ___________________ DISCOVER NETWORK ___________________

TIERED GRID ID 8-pos. Alpha/Numeric TIERED GRID ID 8-pos. Alpha/Numeric CREDIT TIERED GRID ID 8-pos. Alpha/Numeric AMERICAN EXPRESS ___________________
CREDIT TIERED GRID ID 8-pos. Alpha/Numeric
MC DEBIT ___________________ VISA DEBIT ___________________ DISCOVER NETWORK ___________________
TIERED GRID ID 8-pos. Alpha/Numeric TIERED GRID ID 8-pos. Alpha/Numeric DEBIT TIERED GRID ID 8-pos. Alpha/Numeric

MC CREDIT ___________________ VISA CREDIT ___________________ DISCOVER NETWORK ___________________

MPG ID 8-pos. Alpha/Numeric MPG ID 8-pos. Alpha/Numeric CREDIT MPG ID 8-pos. Alpha/Numeric AMERICAN EXPRESS ___________________
CREDIT MPG ID 8-pos. Alpha/Numeric
MC DEBIT ___________________ VISA DEBIT ___________________ DISCOVER NETWORK ___________________
MPG ID 8-pos. Alpha/Numeric MPG ID 8-pos. Alpha/Numeric DEBIT MPG ID 8-pos. Alpha/Numeric

8 . T R A N S AC T I O N I N F O R M AT I O N
FINANCIAL DATA WHERE IS SALE TRANSACTED?
(Must = 100%)
Avg. MC / Visa / Discover Network Ticket
15,000.00
Gross YEARLY Sales Volume (Cash + Credit + Debit + Check) $_____________ 1,000
$_____________
(Estimate If Never Processed in Past)
Store Front / Swiped 80
________%
Average YEARLY MC / Visa Volume $_____________ Avg. American Express Ticket
1,000 Internet ________%
Average YEARLY American Express Volume $_____________ (Estimate If Never Processed in Past) $_____________
Mail Order ________%
Average YEARLY Discover Network Volume $_____________ Highest Ticket Amount 1,000
$_____________
Telephone Order 20
________%
all year
Seasonal? No Yes High Volume Months Open: _______________________________________________________ Total 100
________%
9 . S E RV I C E F E E S C H E D U L E
Accept all MasterCard, Visa, Discover Network and American Express Transactions (presumed, unless any selections below are checked)
MasterCard Visa Discover Network American Express
MC Credit Transactions Visa Credit Transactions Discover Network Credit Transactions American Express Credit Transactions
MC Non-PIN Debit Trans. Visa Non-PIN Debit Trans. Discover Network Non-PIN Debit Trans.
See Section 1.9 of the Program Guide for details regarding limited acceptance.
Discount Collected Daily Monthly
Authorization & Capture Transaction Fees
MC / Visa Auth & Capture Fee: .19
$_________ (Per Item) TransArmor Data Protection Only Auth Fee .05
$_________ (Per Item)
Discover Network Auth & Capture Fee: .19
$_________ (Per Item)

.19
2.00 (Per Item)
Voice Authorization $_________ Electronic AVS Fee .05
$_________ (Per Item)
American Express Auth & Capture Fee: $_________ (Per Item)

American Express Pass Through (existing) SE #: _________________________________ Voice AVS Fee .99
$_________ (Per Item) ARU Fee .65
$_________ (Per Item)

Merchant Initials: ________

DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC
Tao's Acupuncture
DBA Name: _________________________________________________________________________ Merchant #: _____________________________________ Page 3 of 4
OmahaWF1804 9 . S E RV I C E F E E S C H E D U L E (co n td) OmahaWF1807(ia)
Miscellaneous Fees

Dues and Assessments 25.00 (Per Item)

Chargeback Fee $_________ 15.00 (Per Item)
Retrieval Fee (12B Letter) $_________ Return Trans. Fee .05
$_________ (Per Item)

Sales Transaction Fee $_________ (Per Item) Batch Fee .05

$_________ (Per Item) Early Termination Fee 400
$_________ (One Time Fee) elDS Access Fee $_________

EBT Food Stamps $_________ (Per Item) #: ____________________ EBT Cash Benefits $_________ (Per Item) Other: __________________ $_________

0.00
Minimum Monthly Fee $_________ 0.00
Monthly Statement Fee $_________ (Acct on File) Pass Visa Trans Integrity Fee Yes No ACH Reject Fee 35.00
$_________ (Per Item)

MC License Fee $_________ (Per Sales Item) _________% (Sales Volume) $_________ (Flat Rate) Monthly Annually in December

Visa Proc Fee $_________ (Per Item) MC Proc Fee $_________(Per Item) Visa BIN Fee $_________ (Per Item) MC ICA Fee $_________ (Per Item)

Pass Visa Fixed Acquirer Network Fee (FANF) Yes No Visa FANF Card Present Surcharge $_________ (Flat Rate) Visa FANF Card Not Present Surcharge $_________ (Flat Rate)

Pass Visa Acq Processing Fee Yes No Pass Visa Misuse of Auth Fee Yes No Pass Visa Zero Floor Limit Fee Yes No Pass Visa Intl Acquirer Fee Yes No

Pass MC Acquirer Support Fee Yes No Pass MC Cross Border Fee Yes No Pass Discover Data Usage Charge Yes No Pass Visa Acq ISA Fee Yes No
Pass MC Natl Acquirer
Pass MC Proc Integrity Fee Yes No Pass Discover Intl Proc Fee Yes No Pass Discover Intl Service Fee Yes No Brand Usage (NABU) Fee Yes No
Merchant Fee Control Grid Fees User Defined Grid Fees

Annual Fee $_________ Other: ______________________________ $_________ Other: ______________________________ $_________

Wireless Fee $_________
Month _______________ Per item Monthly Annually Month ____________ Per item Monthly Annually Month ____________
Portfolio Mgr Fee $_________
Pass Visa Kilobyte Fee Yes No Visa Kilobyte Fee Surcharge $_________ (Flat Rate) or $ ________ (Per Item)
eMerchantView
Access Fee $_________
Pass Visa AFD Non Participation Fee Yes No Visa AFD Non Participation Fee Surcharge $_________ (Per Item)

Pass Discover Network Auth Fee Yes No Discover Network Auth Fee Surcharge $_________ (Flat Rate) or $ ________ (Per Item) Customer Service Fee $_________

Pass American Express Network Fee Yes No American Express Network Fee Surcharge __________% (Sales Volume) Debit Access Fee $_________

Pass MasterCard Kilobyte Fee Yes No MasterCard Kilobyte Fee Surcharge $_________ (Flat Rate) or $ ________ (Per Item) Supplies:

Pass MasterCard CVC2 Fee Yes No MasterCard CVC2 Fee Surcharge $_________ (Flat Rate) or $ ________ (Per Item) ___________________ $_________

Pass MasterCard ICA AVS Fee Yes No MasterCard ICA AVS Fee Surcharge $_________ (Per Item)
MMS Products$_________
Other: _____________ 19.95
Pass MasterCard Digital Enablement Fee Yes No MasterCard Digital Enablement Fee Surcharge _________% (Sales Volume)

Pass STAR Debit Network Annual Fee Yes No STAR Debit Network Annual Fee Surcharge $_________ (Flat Rate)
TIN / TFN & Regulatory Product Fees
Pass Pulse Debit Network Annual Fee Yes No Pulse Debit Network Annual Fee Surcharge $_________ (Flat Rate)
Reg. Product Fee $________ (Monthly)
Pass Jeanie Debit Network Annual Fee Yes No Jeanie Debit Network Annual Fee Surcharge $_________ (Flat Rate)

Pass NYCE Debit Network Annual Fee Yes No NYCE Debit Network Annual Fee Surcharge $_________ (Flat Rate) 14.95 (Monthly)
TIN / TFN Invalid $________

TransArmor Solution Full Bundle Fee $_________ (Flat Rate) TransArmor Solution PCI Only Fee $_________ (Flat Rate)
Website Usage $________ (Per Item)
TransArmor Data Protection Fee $_________ (Flat Rate) Clover Service Fee Monthly (per station) $_________ (Flat Rate)

Wireless Terminal Monthly Fee $_________ (Per Item) Insightics Solution Monthly Fee (per MID) $_________ (Flat Rate)
IVR Usage $________ (Per Item)
(For the Perka Solution, you will be provided with registration instructions and will be
Perka Solution Monthly Fee (per MID) $_________ (Flat Rate) asked to electronically agree to Perka Inc.s terms and conditions)
Other Item Rate
MC Credit $ Visa Credit $ Discover Network Credit $ American Express Credit $

MC Debit $ Visa Debit $ Discover Network Debit $

Other Volume %
MC Credit % Visa Credit % Discover Network Credit % American Express Credit %

MC Debit % Visa Debit % Discover Network Debit %

Tiered
Discount Fees (Based on Gross Sales Volume)
Discount MPG TXN Fee Discount MPG TXN Fee Discount MPG TXN Fee Discount MPG TXN Fee
MC Qual Credit % $ Visa Qual Credit % $ Discover Network Qual Credit % $ American Express
Qual Credit % $
MC Mid-Qual Credit % $ Visa Mid-Qual Credit % $ Disc. Network Mid-Qual Credit % $
American Express
MC Non-Qual Credit % $ Visa Non-Qual Credit % $ Disc. Network Non-Qual Credit % $ Mid-Qual Credit % $

MC Worldcard Qual % $ Visa Rewards 1 % $ American Express

Non-Qual Credit % $
MC Worldcard Mid-Qual % $ Visa Rewards 2 % $

MC Worldcard Non-Qual % $

MC Qual Debit % $ Visa Qual Debit % $ Discover Network Qual Debit % $

MC Mid-Qual Debit % $ Visa Mid-Qual Debit % $ Disc. Network Mid-Qual Debit % $

MC Non-Qual Debit % $ Visa Non-Qual Debit % $ Disc. Network Non-Qual Debit % $

MC Regulated Debit Disct % $ Visa Regulated Debit Disct % $ Disc. Network Reg. Debit Disct % $

Merchant Initials: ________

DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC
Tao's Acupuncture
DBA Name: _________________________________________________________________________ Merchant #: _____________________________________ Page 4 of 4
9 . S E RV I C E F E E S C H E D U L E (co n td)
ERR
Discount Non-Qual Fees Discount Non-Qual Fees Discount Non-Qual Fees Discount Non-Qual Fees
MC Qual Credit 1.59 % 1.00 % Visa Qual Credit 1.59 % 1.00 % Discover Network Qual Credit 1.59 % 1.00 % American Express
MC Qual Debit 1.59 % 1.00 % Visa Qual Debit 1.59 % 1.00 % Discover Network Qual Debit 1.59 % 1.00 % Qual Credit % %
Pass Through Interchange Includes Dues and Assessments
Discount (Based Discount (Based Discount (Based Discount (Based
on Gross Sales Vol.) on Gross Sales Vol.) on Gross Sales Vol.) on Gross Sales Vol.)

MC Qual Credit % Visa Qual Credit % Discover Network Qual Credit % American Express Qual Credit 0.30 %
American Express has Program Pricing and not
MC Qual Debit % Visa Qual Debit % Discover Network Qual Debit % Interchange and are subject to change.
PIN Debit First Data Payeezy SM Gateway Services First Data Payeezy SM
Payeezy Gateway Participation
Gateway Services Telecheck
Pass Through Other Item Rate .20
$__________ (per item)
Debit Network Fees Payeezy Gateway Effective Date: _________________
.20 (per item)
Other Volume Percent _________% Payeezy Gateway
TeleCheck Payeezy Gateway One Time Setup Fee $________ (one time) TeleCheck Auth Fee $_________
ECA Warranty Mail Order Warranty Single Hold Check Warranty (per item)
Payeezy Gateway Monthly Fee $________ (monthly)
Multiple Hold Check Warranty Paper Warranty C.O.D. Warranty
Payeezy Gateway
Payeezy Gateway Auth Fee $________ (per item)
SE # ___ ___ ___ ___ ___ ___ ___ ___ TeleCheck Deposit Fee $_________
5.00 Payeezy Gateway AVS Fee $________ (per item) (per item)
Inquiry Rate _________% Stmt / Processing Fee $_________
Dec. Risk Surcharge .10
_________% Customer Requested PayPal Auth Fee $________ (per item) Payeezy Gateway
Per TXN Fee $_________ Operator Call (CROC) 2.50
$_________ TeleCheck Adjustment Fee $_________
PayPal Sale Fee $________ (per item) (per item)
Monthly Minimum Fee $_________ ECA Chargeback Fee 5.00
$_________
(Per Location) PayPal Return Fee $________ (per item)
Fleet
WEX: Other Item Rate $________ (per item) Voyager: Qual ________% Other Item Rate $________ (per item)

OmahaWF1804 1 0 . S I G N AT U R E ( S ) OmahaWF1807(ia)
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 and Confirmation Page, which is part of this
Merchant Processing Application (consisting of Sections 1-10), 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 8, Transaction Information section above, you are authorized to accept transactions in
accordance with the percentages indicated in that section. This signature page also serves as a signature page to the Equipment Lease Agreement, and the TeleCheck Services Agreement appearing in the Third Party Section
of the Program Guide, if selected, the undersigned Client being the Lessee for purposes of such Equipment Lease Agreement and/or You and Your for the purposes of the TeleCheck Services Agreement.
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. If 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.
Client authorizes FDMS and Bank and their affiliates to debit Clients 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, 31 U.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 FDMS and Bank.
Clients Business Principal / Officer:

Signature X _______________________________________________ Title __________________________ Signature X _____________________________________________________

Tao He
Print Name of Signer ____________________________________________ Date__________________________ Print Name of Signer ____________________________________________

Signature X _______________________________________________ Title __________________________ Title ________________________________________ Date _____________

Print Name of Signer ____________________________________________ Date__________________________

TELECHECK ACH AUTHORIZATION

ACH Debit and Credit Authorization: Client authorizes its Financial Institution to pay and charge to its account the amount(s) due TeleCheck under this TeleCheck Agreement and to accept all credits and debits made
to its account by TeleCheck via electronic funds transfer in connection with TeleChecks services under this TeleCheck Agreement. This authorization shall remain in effect until (30) thirty days after revoked in writing.

Signature X _____________________________________________________ Print Name / Title: ______________________________________________________ Date _____________

Authorized Signature on TeleCheck Account for ACH

Personal Guarantee: In exchange for First Data Merchant Services Corporation, Wells Fargo Bank, N.A., (a member of Visa USA, Inc. and MasterCard International, Inc.), and TeleCheck Services, Inc. (the Guaranteed
Parties) acceptance of, as applicable, the Agreement, and/or the Equipment Lease Agreement and/or the TeleCheck/TRS Services Agreement, the undersigned unconditionally and irrevocably guarantees the full payment
and performance of Clients obligations under the foregoing agreements, as applicable, as they now exist or as modified from time to time, whether before or after termination or expiration of such agreements and whether
or not the undersigned has received notice of any amendment of such agreements. The undersigned waives notice of default by Client and agrees to indemnify the Guaranteed Parties for any and all amounts due from
Client under the foregoing agreements. The Guaranteed Parties shall not be required to first proceed against Client to enforce any remedy before proceeding against the undersigned. This is a continuing personal guaranty
and shall not be discharged or affected for any reason. The undersigned understands that this is a Personal Guaranty of payment and not of collection and that the Guaranteed Parties are relying upon this Personal
Guaranty in entering into the foregoing agreements, as applicable.

Personal Guarantee Signature X _________________________________________________ Print Name: Tao He

________________________________________ Date _____________

Personal Guarantee Signature X _________________________________________________ Print Name: ________________________________________ Date _____________

Accepted By First Data Merchant Services Corporation Wells Fargo Bank, N.A., (a member of Visa USA, Inc. and MasterCard
International, Inc.), 1200 Montego, Walnut Creek, CA 94598

Signature X _____________________________________________________________ Signature X _____________________________________________________________

Title _________________________________________________________ Date _____________ Title _________________________________________________________ Date _____________

Bank Copy - White Sales Representative Copy - Yellow Merchant Copy - Pink
DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC

Clover Go Addendum
(New and Existing Merchant / Locations)

Sales Channel: _________________________________________________________________________________

Existing MID #: __________________________________ New MID #: ____________________________________

Sales Rep Name: ________________________________ Sales Rep ID: ___________ Phone: ________________

1. Business Information:

Clients Business Legal Name: __________________________________________________________________

Same as Legal Name or provide:

DBA Name: ____________________________________________ Title:________________________________

Your Business Phone: _____________________________ Your Business Fax: _____________________________

2. Clover Go Service Fees:

Clover Go Setup Fee $___________

Clover Go Monthly Fee (per device) $___________

Clover Go Reader $___________

The terms of this Clover Go Addendum (the Addendum) shall serve to supplement the terms of your Merchant
Processing Application and Agreement (the Agreement). By signing below, you acknowledge that you have read,
understand and agree to comply with the terms and fees, as set forth in this Addendum. You also understand that
the above fees may be modified from time to time in accordance with your Agreement. Except as expressly set
forth herein, the Agreement is hereby ratified in all respects and shall remain in full force and effect.

Clients Business Principal:

Signature (please sign below):

X ____________________________________________________ Title: _____________________________ Date: __________

The party signing this Addendum must be the same party signing the Merchant Processing Application and Agreement.

Print Name of Signer:_______________________________________________________________________________________

CloverGoAdd1808(ia)
DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC
DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC

Premium Price Guarantee

This agreement dated ___________is hereby entered between MiCamp Merchant Services herein referred to as Company and
_______________________________ herein referred to as Merchant.

In consideration for the term of the Merchant Processing Application, Company guarantees the rates offered during the initial term of
this agreement, with the exception of mandatory increases set forth by Visa/MasterCard. Merchant further acknowledges that no other
agreements or stipulations have been made either verbal or otherwise and that these agreements represent the entire agreement.

In order that company may provide pricing as shown in the Merchant Processing Application, merchant agrees to process its credit
and/or debit card transactions exclusively with company for the term outlined in the Program Guide and its addendums provided to
Merchant. Upon expiration of the initial term, this agreement will automatically renew for a period of thirty-six months unless written
notice is received by Company from Merchant within thirty days of expiration of the initial term

Merchant acknowledges and agrees that company and or its affiliates have the right to debit directly from merchants accounts any and
all fees due in connection with and as stipulated to in the Merchant Processing Application and its addendums. Additionally, in
consideration for the term, Company agrees to waive fees noted on the Enhanced Tier 1 Pricing Model. These fees are considered
earned on date of signing. Merchant acknowledges that these fees represent costs to Company, in the event that merchant terminates
this agreement prior to the expiration of the initial term, all waived start up fees will become immediately due and payable to the
Company. Upon termination, merchant authorizes the company to immediately debit all amounts owed company from merchants
DDA account. Merchant further acknowledges that company is not a representative of, or affiliated in any way with their current bank.
Any lease agreements entered into by merchant as a result of this or any other agreement will continue regardless of the processing
status of the merchant with company.

In the event any dispute or controversy arises between the parties to this agreement, whether directly or indirectly, said dispute or
controversy shall be determined by final and binding arbitration. Each party shall name an arbitrator within twenty (20) days after one
party gives written notice to the other party of such a dispute or controversy. The two arbitrators shall select a third arbitrator within
fifteen (15) days of their appointment. If any party fails to select an arbitrator within twenty (20) days after receiving notice of a
dispute or controversy, or if the two arbitrators fail to select a third arbitrator within fifteen (15) days after they have been appointed,
then the presiding Judge of the Superior Court of Maricopa County, Arizona shall appoint such other arbitrator or arbitrators.

The arbitrators shall render a decision within sixty (60) days after their appointment and shall conduct all proceedings pursuant to
Arizona Revised Statutes Sections 12-1501, et seq., and the Rules of the American Arbitration Association governing commercial
transactions then existing, to the extent that such rules are not inconsistent with said statutes and this agreement. Judgment upon the
award rendered under arbitration may be entered in any court having jurisdiction. Each party shall pay its arbitrators fees and on half
of the third arbitrator. Any other costs of arbitration including attorneys fees shall be paid by the party incurring said costs or fees.
The parties agree that the arbitration procedure provided herein shall be the sole and exclusive remedy to resolve any controversy or
dispute rising hereunder, and that the proper venue for such arbitration proceedings shall be in the City of Phoenix, County of
Maricopa, State of Arizona. The parties specifically waive their right to seek remedies in court, and specifically waive their right to a
jury trial. Under no circumstances shall the arbitrator award consequential or exemplary damages. This arbitration provision shall
survive the termination of this agreement and the termination of the transaction. In the event either party to this agreement shall hold
the joined party harmless against any and all claims, losses, costs, expenses (including reasonable attorneys fees) damages or
liabilities paid or asserted against the joined party.

Merchant:

____________________
Business Name

_____________________ _________________________ ___________

Printed Name & Title Signature Date

Accepted by: (internal use)

_______________________ ________________________ ____________

Printed Name & Title Signature Date
DocuSign Envelope ID: 583FAD57-8573-4A5E-BE4C-2FD6D0DA06CC

Account approval and maintenance requires proof of a valid bank account on file.
Please provide a copy of a voided check or a bank letter.

(Affix void check here)

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MiCamp Solutions is a registered ISO/MSP of Wells Fargo Bank, N.A., Walnut Creek, CA. 2010
MiCamp Solutions. All rights reserved.