1547 BB & T Xpress-Pay.comPURCHASING DEPARTMENT
TRANSMITTAL ME MORANDUM
To: City Manager
RE BB& T Xpress - Pay.com Enrollment Agreement for Utilities
The item(s) noted below is /are attached and forwarded to your office for the following action(s):
■
■
■
■
Development Order
Final Plat (original mylars)
Letter of Credit
Maintenance Bond
Ordinance
Performance Bond
Resolution
❑
Mayor's signature
❑
r mg
❑
C E ,
Safe keeping (V, ay *--
_
_ Deputya ity Manager
); r} - ,
❑
Payment Bond
®
City Manager Signature
❑
City Clerk Attest/Signature
Once completed, please:
❑ Return originals to Purchasing
❑ Return copies
El
Special Instructions:
Execute Agreement
Marisol Ordonez
From
Date
T: \Dept forms \City Clerk Transmittal Memo - 2009.doc
�i i �
�vreA11FAVA!fPay. c3om
Enrollment
Agreement
Thank you for enrolling with Xpress - Pay.com, the Universal eCommerce Solution from Systems East, Inc.
Your enrollment allows you to collect any type of bill or payment, over the counter or over the Internet,
twenty -four hours every day. We will provide and maintain the web site and financial transaction interface;
you are responsible for any information which is hosted by the site and under your jurisdiction. Initial
training and continuing support are included with your enrollment.
To inform customers of participation, you agree to include a link on your web site and provide a notice on
bills. To facilitate Internet payments, a merchant account is required. Visitors may be charged a site fee in
accordance with the chart set forth on page two. The complete terms of services and policies may be
viewed at www.xpress- pay. com /admin /pdfs /enrollment_policies.pdf.
Merchant legal name
City of Sanford
Interface type
Merchant DBA name
For shopping cart interface
Name Telephone number
Contact name & telephone
Name
Telephone number
(person responsible for
William Marcous
(407) 688 -5105
account setup)
Best time to call M =Tb 7;00430
Contact email
marcousw @sanfordfl,gov
300 N Park Ave., Sanford, FL 32771
Complete billing address
Name
Telephone number
Sales representative name &
telephone number
Best time to call
Merchant fee & gateway fee
Federal tax ID# Bank routing#
Bank account#
billing account information
59- 6000425
If checked, see instructions to
Electronic check option
❑ Also accept electronic checks (eChecks)
representative on page three
Telephone payments (IVR)
Q Also accept voice payments (add $150 setup plus $0.90 per payment)
Special instructions
Processing structure
Types of bills to be collected
Utility
Interface type
❑ Standalone ❑ Shopping cart
For shopping cart interface
Name Telephone number
software provider technical
contact name and telephone
6 Locust Avenue The Universal Collection Solution Enrollment Agreement
Cortland, New York 13045 www.xpress- pay.com Version 1.39
(607) 753 -6156 Page 1 of 7
�pz-ei jAr!!pay corn enrollment profile
CrprlifiriPhif r_ard fPp structure- Check one and complete all em oty boxes in column
eCheck fee structure (if applicable per oaae one)
12
eCheck
per transaction fee
❑
❑
❑
0
#
Option i
Pass through
Split charge
Split fee
Absorbed by
Component 4
O
p
p
merchant
14
Transaction
Downgrades
None (fixed
$5.00
All merchant fees
1
costs borne
and
merchant discount
All merchant fees
plus site fee
by merchant
assessments
rate /fees required)
Transaction
Base discount
All (discounts,
2
costs borne
rate, transaction
per transaction fees,
Site fee
None
by visitor
fees, site fee
and site fee)
Merchant provider
%
Per
Per
3
credit/debit
%
(plus 0.12% assm't;
merchant
merchant
discount rate
(base rate)
fixed rate required)
application
application
4
Bank card
$
$
Per merchant
Per merchant
per-transaction fee
p
per transaction
per transaction
application
application
PP
$
$
Per merchant
Per merchant
5
Card brand fee
per transaction
per transaction
application
application
eCommerce
$
$
Per merchant
Per merchant
6
gateway
per- transaction fee
per transaction
per transaction
application
application
7
Gateway one -time
Per merchant
$
Per merchant
Per merchant
activation fee
application
application
application
Gateway monthly
Per merchant
$
Per merchant
Per merchant
8
access fee
application
per month
application
application
Xpress -Pay account
$0
$10.00
$0
$0
9
maintenance fee
per month
per month
per month
per month
10
Xpress -pay site fee
a
0.7 /0
o
0.7 /0
0
0 /0
0
0 /o
percentage
11
Xpress -pay per
$0.25
$0.40
$2.50
$0.50
transaction site fee
eCheck fee structure (if applicable per oaae one)
12
eCheck
per transaction fee
$0.47
$0.47
$0.47
$0.47
13
Xpress -pay
$2.03
$2.03
$2.50
$0.50
per - transaction fee
14
Gateway monthly
$5.00
$5.00
$5.00
$5.00
access fee
per month
per month
per month
per month
Notes: For option O, complete lines 3, 4, 6, or for option Q , complete lines 3, 4, 6, 7, and 8,
using the information in the merchant account application
Definitions for options through ® are on the following page.
6 Locust Avenue The Universal Collection Solution Enrollment Agreement
Cortland, New York 13045 www.xi)ress- pay.com Version 1.39
(607) 753 -6156 Page 2 of 7
ii�e�reclrs�y.QOm enrollment acceptance
O Single charge to visitor, all payment proceeds to merchant; merchant is subsequently billed by the
merchant provider for all merchant fees and by Systems East for Xpress -Pay fees.
O Fixed discount rate and per transaction fee required. Bill proceeds to merchant, site fee (billed as
separate charge to visitor) to Systems East. Systems East pays all merchant discounts and transaction
fees. Systems East will subsequently bill merchant for all merchant fees excluding merchant discounts
and transaction fees. These additional fees may include, but are not necessarily limited to, initial account
setup fees or recurring monthly statement fees as stated on page two; chargeback processing fees, PC[
compliance fees, early termination fee, annual fees, and one -time or other fees as assessed by the
merchant provider. Systems East billings for fixed -fee monthly items will be on a quarterly basis at the
beginning of the quarter to which they apply. Note: For municipal and insurance sectors only.
Oa Bill proceeds to merchant, site fee (billed as separate charge to visitor) to Systems East. Merchant is
subsequently billed by the merchant provider for all merchant fees. This is the typical rate structure for
commercial entities.
® Visitor pays exact amount due to merchant with no site fee, all payment proceeds to merchant. Merchant
is subsequently billed by the merchant provider for all merchant fees and by Systems East for the
Xpress -pay site fees.
Additional terms and conditions:
Public awareness is an imperative in the success of this eCommerce endeavor. As a component of your
acceptance, you agree to place a prominent "Pay bills online" link including the Xpress - Pay.com logo (as
above and in perspective) on the home page of your web site, and to provide notification and a URL (Pay
online at www.yourwebsite.com) on printed bills.
Fees accrued pursuant to this agreement will be automatically deducted from the bank account specified on
page two hereof on either a monthly or quarterly basis.
If the option to accept telephone payments is not selected at the time of execution of this agreement, you
may add the option at any later date through a written or emailed notification for the cost set forth herein.
Acceptance
Approval and acceptance
Merchant
Signature
Printed name and title
Name Title
Tom Geor e - Deputy City Manager
Date
r
Instructions to merchant: Please return4 your sales representative
Instructions to sales representative: Submit Systems East documentation with new merchant
account package.
Instructions to Application Processing: Send this agreement with a copy of the merchant
provider rate schedules to Systems East by:
• Email as a PDF to enrollments @xpress - pay.com, or
• Fax to (607) 753 -1047
• Note: If merchant is also accepting electronic checks, please also provide supporting
documentation (page 4) and complete the Client Profile (pages 5 -7)
6 Locust Avenue The Universal Collection Solution Enrollment Agreement
Cortland, New York 13045 www.xpress- pay.com Version 1.39
(607) 753 -6156 Page 3 of 7
Client Profile
If the merchant will be accepting electronic checks (eChecks), we will be required to secure an
eCheck merchant account on behalf of the applicant. To do so, we will need the substantiating
documentation listed on this page and a completed Client Profile found on the following pages.
When the documentation has been gathered and the Client Profile has been completed, please
forward the material with the information as specified on the previous page. The additional
information in the checklist below is required to accompany your applications.
❑ Balance sheet as of the close of the most recent fiscal year (two fiscal years for
commercial entities)
❑ Income statement as of the close of the most recent fiscal year
❑ A voided check from the bank account to receive payment proceeds
❑ A complete copy of all pages of the two most recent bank statements for the account to
receive payment proceeds (note: a copy of your cancelled checks not needed)
❑ Note: If for any reason, you cannot provide a voided check and a copy of the bank
statements, a letter from the bank is required. The bank's letter must indicate the account
owner's name, routing number, account number, and the names of the persons having
signatory authority
❑ A government - certified document substantiating the formation of your firm
❑ Proof of signatory authority for this firm in the form of articles of incorporation, board
minutes, or a letter on company stationery from the corporate secretary.
All information provided will remain confidential and will only be used as required for the application
process.
6 Locust Avenue The Universal Collection Solution Enrollment Agreement
Cortland, New York 13045 www.xpress- pay.com Version 1.39
(607) 753 -6156 Page 4 of 7
Client Profile (page 1 of 3)
Note: Complete only if merchant is accepting eChecks
Demographic Information
Owner /cor oration /munici pal i name
City of Sanford
DBA name if different
Email address
• Sole proprietorship
Date of birth, percentage of ownership
• Partnership
Structure (check one)
❑ Limited liability corporation (LLC)
❑ S corporation
Ownership & length
❑ C corporation
Physical address
City, state, zip code
Driver's license
Billing address (if different)
Have you ever declared bankruptcy?
If yes, attach discharge documents
City, state, zip code
❑ Yes, in (year)
Office telephone number
❑ No
Customer service number
Fax number
Number of employees
Longevity
Years established:
Years under current ownership:
Federal tax ID number
59- 6000425
Web site address URL
First Responsible Party (person to have jurisdiction over the merchant account)
Name and title
Email address
Date of birth, percentage of ownership
DOB:
W
Home address, city, state, and zip code
Ownership & length
❑ Owned or ❑ rented for years
Social security number
Driver's license
State: Number:
Issue date: Expiration date:
Have you ever declared bankruptcy?
If yes, attach discharge documents
❑ No
❑ Yes, in (year)
Are you currently involved in any pending
legal actions?
❑ No
❑ Yes (attach description)
6 Locust Avenue The Universal Collection Solution Enrollment Agreement
Cortland, New York 13045 www.xpress- pay.com Version 1.39
(607) 753 -6156 Page 5 of 7
Client Profile (page 2 of 3)
Second Responsible Party: Please complete these items if your firm is a partnership
or corporation in which the first responsible party (above) has an interest of 50% or less
Name and title
❑ Checking ❑ Savings
Email address
Date of birth, percentage of ownership
DOB: %:
Home address, city, state, and zip code
Ownership & length
❑ Owned or ❑ rented for years
Social security number
Driver's license
State: Number:
Issue date: Expiration date:
Have you ever declared bankruptcy?
❑ No ❑ Yes, in ear
Are you currently involved in any pending
legal actions?
❑ No ❑ Yes (attach description)
Financial institution information for account to receive proceeds from payments
Bank account type check one
❑ Checking ❑ Savings
Bank name
Bank contact person
Bank address
Bank address continued
Bank city, state, zip code
Bank area code and telephone number
Bank routin # see image on next page
Bank account# see image on next page
Sample from the bottom left of a typical
check. It is provided to assist you in
ascertaining the routing and account
numbers required above.
ChochlnoAccount
ktOOOa 1t4 4 M616 8616 X884
-- - -
eank Routing Number flank Account Humber
6 Locust Avenue The Universal Collection Solution Enrollment Agreement
Cortland, New York 13045 www.xpress- pay.com Version 1.39
(607) 753 -6156 Page 6 of 7
Client Profile (page 3 of 3)
Electronic check transaction parameters
Average eCheck transaction amount
Largest anticipated eCheck transaction
amount
Utility
Anticipated number of monthly eCheck
transactions
Anticipated eCheck monthly dollar volume
0 Yes ❑ No
Additional information
Types of bills to be collected
(insurance premium, taxes, rent, utilities,
Utility
parking tickets, etc.)
Do you currently accept credit/debit cards?
0 Yes ❑ No
If yes, merchant provider name (also please
BB &T as of 12/4/2012 None available
p rovide two most recent statements
Email address to receive payment
notifications
6 Locust Avenue The Universal Collection Solution Enrollment Agreement
Cortland, New York 13045 www.xpress- pay.com Version 1.39
(607) 753 -6156 Page 7 of 7