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M E R C H A N T P R O C E S S I N G A P P L I C A T I O N A N D A G R E E M E N T

(Page 4 of 4)

DBA Name: _____________________________________________________________________________

Loc. ______ of ______

(8 ) A G R E E M E N T A P P R O V A L

APPLICABLE IF MERCHANT ACCEPTS AMERICAN EXPRESS

CARDS: 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 First Data Merchant Services Corporation (“FDMS”), American Express Travel Related Services Company, Inc. (“AXP”) and AXP’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, and disclose such information to their agent, subcontractors, Affiliates and other parties for any purpose permitted by law. I authorize and direct FDMS and AXP and

AXP’s agents and Affiliates to inform me directly, or through the entity above, 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 AXP to use the reports from consumer reporting agencies for marketing and adminis -

trative purposes.

I understand that upon AXP’s approval of this application, the entity will be sent the Agreement and materials welcoming it, either to AXP’s program for FDMS to perform services

for AXP or in AXP’s standard Card acceptance program, which has different servicing terms (e.g., different speeds of pay). I understand that if the entity does not qualify for the

FDMS servicing program, that the entity may be enrolled in AXP’s standard Card acceptance program, and the entity may terminate the Agreement. By accepting the American

Express Card for the purchase of goods and/or services, or otherwise indicating its intention to be bound, the entity agrees to be bound by the Agreement.

APPLICABLE TO ALL MERCHANTS: By signing below, each of the undersigned represents that they have read and are authorized to sign and submit this Merchant Pro -

cessing Application and Agree ment (“Merchant Processing Application”) for the above named Client (“Client”) and that all information provided herein is true, complete, and

accurate. Client acknowledges having received and read a copy of (i) the Interchange Qualification Matrix, (ii) the Non-Qualified Rate Schedule (specific to Client’s industry),

Interchange Rate Schedule or Qualification Tier Rate Schedule, as appli cable to Client’s Pricing Method, (iii) the Program Guide (which includes terms and conditions for each

of the services, Operating Procedures, Additional Agreements (as defined below), Additional Important Information for Card Processing, and a Confirmation Page), and (iv) the

Merchant Processing Application, consisting of Sections 1-9, (together, the Merchant Processing Application, its attachments and schedules and Parts I and IV of the Program

Guide are referred to in this Section 10 as the “Merchant Agreement”), as modified from time to time in accordance with the applicable provisions of the Program Guide, and

agrees to be bound by all provisions as printed therein. Client hereby consents to receiving commercial electronic mail messages from us from time to time. This signature

page also serves as the signature page to the Equipment Lease Agreement and the American Express

Card Acceptance Agreement (for purposes of this paragraph, the “AXP

Agree ment”), which appear in Part II of the Program Guide, (for purposes of this para graph, together, the Equipment Lease Agreement and AXP Agreement are the “Additional

Agreements”), if selected; the Client being the “Lessee” for purposes of such Equipment Lease Agreement and/or “You” and “Your” for the purposes of the AXP Agreement.

By signing below, each of the undersigned authorizes Banc of America Merchant Services, LLC (“Processor”) and Bank of America, N.A. (“Bank”) (together, Processor and Bank

are “Servicers” and also referred to as “our,” “us” and “we” in this Section 10) to (a) request and obtain from consumer reporting agencies, individual and business credit reports

(collectively, “Credit Reports”), in connection with the approval of this Merchant Processing Application and any maintenance, updating, renewal or extension of the Merchant

Agreement (if this Merchant Processing Application is approved), and (b) exchange Credit Reports and any other information about each of the undersigned personally with

First Data Merchant Services Corporation and any other service providers, to the extent such parties provide services that Client has selected on this Merchant Processing

Application (or as hereafter elected by Client). Each of the undersigned furthermore agrees that all references, including banks and consumer reporting agencies, may release

any and all individual and business credit financial information to us. Each of the undersigned further authorizes us to disclose any information obtained from any source in

connection with this Merchant Processing Application, including Credit Reports, to any governmental, administrative or regulatory entity, upon request, or to each other and

our respective vendors and affiliates, as necessary to provide the products and services elected under the Merchant Agreement, or to comply with applicable law or order,

including, without limitation, the USA PATRIOT Act. It is our practice to obtain certain information in order to verify your identity while processing your Merchant Processing

Application, as described in the USA PATRIOT Act.

THIS MERCHANT PROCESSING APPLICATION AND AGREEMENT HAS BEEN EXECUTED ON BEHALF OF AND BY THE AUTHORIZED MANAGEMENT OF CLIENT AS OF THE

EFFECTIVE DATE.

Client’s Business Principal:

(Please sign below)

(PROCESSOR): Banc of America Merchant Services, LLC

(BANK):

Bank of America, N.A.

Signature____________________________________________________________________

Print Name _______________________________________________________ Date ________________

Signature _________________________________________________

■ ■

Title:

Pres.

V.P.

Member L.L.C.

Owner

Partner

Other: ___________________________

Signature____________________________________________________________________

Print Name _______________________________________________________ Date ________________

■ ■

Title:

Pres.

V.P.

Member L.L.C.

Owner

Partner

Other: ___________________________

GP1308(ia)

(9 ) P E R S O N A L G U A R A N T Y

GP1308(ia)

In exchange for Banc of America Merchant Services, LLC, Bank of America, N.A., and American Express’ acceptance of, as applicable, the Agreement and/or the Equipment

Lease Agree ment and/or American Express Card Acceptance Agreement, the undersigned uncon ditionally guar antees performance of the Client’s obligations under the fore -

going Agree ments, and payment of all sums due thereunder, and in the event of default, hereby waives notice of default and agrees to indemnify the other parties for any and

all amounts due from Client under any of the foregoing Agree ments. I understand that this is a Guaranty of payment and not of collection and that Bank of America, N.A., Banc

of America Merchant Services, LLC, and American Express are relying upon this Guaranty in entering into, as applicable, the Agreement, the Equipment Lease Agreement, and

American Express Card Acceptance Agreement.

Signature

(Please sign below)

___________________________________________________________

, an individual