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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