The URL can be used to link to this page

Home My WebLink AboutNorthern Leasing System, Inc. Augusta Richmond GA DOCUMENT NAME: f\l 0 KT It e:1C.10 UAC ,I\IJ. S, y <;7 ,;; M ~ I 'j: ('C.. DOCUMENT TYPE: LEA-S~ YEAR: t q q 7 BOX NUMBER: l.Q FILE NUMBER: 1 Ll o SOt NUMBER OF PAGES: 1 ~ ~ . ,;- " Region~ ~ Bank WOVA- II'...O"....TIO.. .~.T~"".. I...C. Registered Member Service Provider Regions Bank BOBBY C. LAWSON, JR. Senior Sales Executive . c/o Regions Bank Building 111 Green Street, 5th Floor Gainesville, GA 30501 Office (770) 503-2337 Fax: (770) 503-2680 Lease Start Date r. (For Office Use Only) .:... :,~TLnIJ 1 S , -:;.:!"'\""":::.t .-.~. J~ ... '.. . .7:':-~M ~'.~..""I\;,:;r.: .)::..-...~..;~ _. ~:..:.IZ..! "t; ::"':.;.:"".Sl~;r: :..;~:.s 9",,:':.:Jf') V;~h -\il1"J(,.<~)~.,' r' '~r/'r,:;;;r;, 'o:::I~..,;; '.j'o "":x;"'q ,~-.,., .~..- '. Ci :' -:VT vu;::'t""Vl.-..):;..~ -~,'.; :,~_~' ..;.'~. State .....' " ;' . -"'2:.). . . . "':;t ,;::r:<. f-j9;E~~J .:n;;::1S1.~a ;(\ r.19f"":" '1~:: 'i~ . ...... '; -r e of Business''-:''; ~,o '" 9;".' ;;"" "~,:., Years il . ',,'- -- "....." .... 'l,-,-~l/G I~) \,V~.~ ~~.~ -';."i.'.~ .,,-,.. ..'':-: .-..' ',-' . :-..;. '\ " . :0.' Bus;"l1l:lsS Ad"a;:~sS(lf aifferent from above) - .:r'~ '!.. : . State County Zip cod +v "1~ c.t-t1_~~ ~ tc'-, I L2--~ II. "H...:' 't., T ~QUIPMENT SUPPLIER Supplier Name NOVA Information Systems. Inc, Address Five Concourse Pkwy, City Atlanta State GA EQUIPMENT & PA YMENT INFORMATION. Description (Manufacturer, Mode..!L. FOf2-ff2tlnl c S }.=ql; T+ --' lS. Quantity / .ABOUT YOUR BANK tJJ( Branch State Contact Person fZ.o tvJJ Telephone ( I, (Lessee) in the capacity set forth below hereby authorize Northern Leasing'Systems, Inc., or its designee, successor or assign (hereinafter "LESSOR") to withdraw any amounts including any and all Sales Taxes now due or hereinafter imposed, owed by me in conjunction with the above referenced Transaction by initiating debit entries to my account at the Financial Institution (hereinafter BANK) indicated above. or as such other BANK as the Lessee may from time to time use: in the event of default of my obligation hereunder, I authorize debit of my account for the full amount due under this Lease Agreement. Further, I authorize BANK to accept and to charge any debit entries initiated by LESSOR to my account. In the event that LESSOR withdraws funds erroneously from my account, I authorize LESSOR to credit my account for an amount not to exceed the original amount of the debit. This autho- rization is to remain in full force and effect until LESSOR and BANK have received written notice from me of its termination in such time and in such manner as to afford LESSOR and BANK a reasonable opportunity to act,; .- ,... Lessee's SignaturemtJe ~~;~?ff;~~j?1t~~'~'.~-~ ~ ;~:~f~.~:-~.:!c: - ;~~:.: Date }Print Name Home Address City Slale Social Security # LEASE ACCEPTANCE Undersigned agrees to all terms and conditions contained in this Equipment Lease Agreement. THIS IS A NON-CANCELABLE LEASE FOR THE FULL TERM INDICATED HEREIN. INVESTIGATIVE CREDIT REPORT: Applicant authorizes Northern Leasing Systems. Inc" its agents or assigns. or their agents to obtain an investigative credit report from a credit bureau or a credit agency and to investigate the references given on any other statement or data obtained from the lease applicant. . C-k. j .. nths [ t~~ :> I U. ,.:. ~':",:":.~}-V' ''', .... '.: :,,"-S:O."-':u.:,' ~".., .' . ..' c/t(} e.. Print Name' Date , - "-~ _..: " " l' _' . .. c~,.;.." =, .:.. -'.:... ,.;.., , . , Undersigned u~CO~ditio'm;illy~tiarantees performance of this Lease by Lessee and payment of all sums due thereunder in the event of default. hereby waiving any modification, amendment or extension and notice thereof. .' . .. .... ..",d,.. ' Personal. Guarantor's Sig'natur'e ,~Y{-J.~~~~~~~1?~~{iZiF$~~i~;;J:;:"\2,; p'n'nt Name /ILl AI C. "'} () - ..~.~.:~~..:....ii~-.,';..~'.:"~..: ,~- ~,.._.rl;:r\ ",~.- . ,., -', f"'f/:::J , 'f ~ ~ Date , An Individual Home Telephone ( ) . . . _.....~, ....r".t".;"..~. ''"!'--''I'''~'"' '.~~(1 ''';''t''~ #.~.~ .. ACc.eptance By Northerr!.Leasfng Sysiems. Inc.- Signaluremtle ~,.;.,~.;: ;: ~.~~~~~:.;~::~;:~"~;~~~~f;~~;;;~;:l{ :.~:~:2:,;t.;~;.;~ ;:-' ,:~'~::. ~'... 1.;:1:\':...'.'; ll~if~~": r3~ j;UJ~fj!,'~1 -. -"Jj';}j.. :.x;;..~;~~ ~;{:~... ~....tv: * -,'r ~;..:o.-.t ..-.: ::.:' . .,. .., ''';'' ~ . ,,,,:,:,:Page 1 of 4 ~~lh1~~~;:;' Print Name Date i:....'t"t.: "," ,.;. . "f "::,'. ...... ~...~ I;: . t .l<r.~, _---..;;,_u_ ......:.. .::- .:~~::--:.:. -. _ ~ I . .i'.' .:t~r~~?{ " . ~~'iablishnient Services AMERICAN EXPRESS@ CARD ACCE;PTANCE AGREEMENT ..~ This American Express@ Card Acceptance Agreement ("Agreement") becomes effective upon approval of your business entity ("you" and related words) to accept the American Express Card by American Express Travel Related Services Company, Inc. and its subsidiaries, affiliates and licensees that issue cards ("we" and related words). If we approve your application, you agree to accept cards issued by us and bearing our name, trademark, service mark or logo ("Cards") according to the terms of this Agreement. You agree to accept Cards for the purchase of all goods and services sold (except as noted below) at all locations in the United States, Canada, the U.S. Virgin Islands and Puerto Rico operating under the trade name written below in payment for all goods and services sold (except as noted in the Agreement). This includes sales made in person, by telephone, by mail 0.' by any other method. Each location or method of conducting sales is an "Establishment". "Card- member" means the person whose name is embossed on the face of the Card. Purchases made with the Card are "Charges".. By signing below, you agree to be bound by this Agreement. The Shaded Box Will Be Completed By The Sules Agent ~;EsXl::ijr'ofat(tNanie: : S I A t ID # "3 ~ ;"':'ii*'C";S~;"'P."-;':' " . . . , . a es gen' '.~'~~~r~f~?:~ip.r~s~.'~,i"~~i~lDtRaie/." .EDCD~D D % Paper D.DD % !;.~~~~!~~:(~.;Estimated~DIIIIJ Pay DD~Y 'D~;y D~~y :~nnual:AmenCan Express Charge Volume . Average TIcket Frequency '':'';-io''''~.''~'~~,:-:'::'''\:.c. ~~~',-, 7:;: .-",<~..: . '. ." , . . . . Franchise Name: . '.', Franchise CAP #: ..... ;.:'':......._. ~..;-. '.4. _I" . What Is Your Name & Address? Pleuse Complete The following, If You Huve An)' Questions Call 1-800-448-7131. FULL LEGAL NAME of Corporation, Partnership or Proprietorship ~0J~0@D~~~~~~~~~DDDDDDDDDDDDD Doing Business As (DBA, Trade Name) ~~~~~~~G~0~~B~~~D~~~G0~DDDDDD ~~sD~El[!]DD~~rJD~00@)@~D 1][8~~ttJDDDD City State Zip Code ~~~~~0~DDDDDDDDODDD ~~ ~@~~0 Signer Information Name: La-fl,~ e. _<)t!en'1 {J.fi-J Social Security ~mber: 253-72-4875 Home Address: 3052 Richmond Hill Rd City: Augusta State: GA Zip: 30906 Have You Previously Had An American Express Merchant Account #: DYes @No Title: /YI~ 0 e. If Yes, Merchant #: By signing below, I represent that I have read this Agreement and that the busin.ess entity indicated above agr es e bound y is Agreement. .~ .~;.~!' . Please Sign Here X .f"'.. . .~ Date: ~1'?7 FS,AP A\!re~m('nl (.1'17(,'17 1'11)(, ,i . -; .. T . HONORING CARDS You shall honor all Cards properly presented in accor- dance with this Agreement. When a customer asks what payment methods you accept you shall mention the American Express Card, When a Cardmember makes or requests to make a pur- chase with the Card, you shall: · not in any way try to persuade the Cardmember to use any other payment method; · not offer to extend credit or charge services .to the Cardmember for that transaction through your own or any other charge, credit, debit or similar card or service; or · not criticize or mis-characterize the Card. You shall not discourage any Cardmember from using the Card, You shall not impose any restrictions or conditions on the use of the Card that are not imposed equally on the use of all other charge, credit, debit or similar cards or services. You shall not state or publish a preference for any other charge, credit, debit or similar card or service over the Card. You shall not promote the use of any other charge, credit, debit or similar card or service (except for your own card which is issued solely by you and is usable only at your Establishments) more actively than you promote the use of the Card. You shall display American Express signs, decals or other identification prominently at your Establishments, including our "Take-One" containers filled with Card application forms. You will receive a $3.00 commission when we open a new Card account .based upon a Card application from your Establishment. DISCOUNT The amount we charge you for accepting the Card (the "Discount") is a percentage of the face amount of Charges you submit ("Discount Rate"). The initial Discount Rate is the percentage indicated on the first page of this Agreement. The Discount will be deducted from your payments. Effective every April 1 st (begin- ning after your first full calendar year of Card accep- tance) we may adjust the Discount Rate. In addition, since the Discount Rate is based in part upon the sub- mission method and payment plan you elect, we may adjust the Discount Rate accordingly if these change. We further have the right to adjust the Discount Rate at any time. Different Discount Rates may apply to Establishments in Canada. ~ 2 PAYMENT We will pay you in United States Dollars for the face amount of Charges you submit, minus: 1) our Discount; 2) any amounts you owe us; and 3) any Credits you submit. We will send payment to you in accordance with the payment plan you selected. Establishments located in Canada must submit Charges in Canadian Dollars and will be paid in Canadian Dollars, You may not receive payment on behalf of any other entity. Electronic Pay . You must participate in our Electronic Pay Program ("Electronic Pay") unless: · You do not have a bank account and cannot get one or · Your bank does not have access to the Federal Reserve System to receive Automated Clearing House transactions. Payments will be sent electronically via the Automated Clearing House of the Federal Reserve System ("ACH") to the demand deposit account you designate ("Account") at a bank ("Bank") that participates in ACH. We will initiate payment via ACH within three (3) business days of receiv- ing and processing Charge Data. If your payment date falls on a day that our bank is not open for processing ACH pay- ments, we will initiate payment on the next day our bank is open for processing ACH payments. You must provide us information about your Account and your Bank, and you must notify your Bank that w~ may have access. to the Account. We will not be responsible for any obligations or liabilities, including but not limited to incidental or conse- quential damages, over and above the amount of the applicable debit, credit or adjustment to your Account in the event that any such debit, credit or adjustment is not hon- ored by your Bank or is improperly applied to your Account. There is an additional fee of 0.15% of the face amount of Charges you submit for participation in Electronic Pay. However, if you obtain Authorization for Charges electron- ically and transmit Charge Data to us electronically, you will not be charged the additional fee for participation in Electronic Pay. Payment by Check If you are paid by check, there are three (3) alternatives as described below: Basic Payment Plan: Payment is sent within three business days after we receive and process Charges, Economy Payment Plan:' Payment is sent fifteen calendar days after we receive and process Charges. Extended Payment Plan: Payment is sent thirty calendar days after we receive and process Charges. If you are paid by check, we will charge a processing fee of 95<,1: per check. . , FULl- RECOURSE Full Recourse means that we have the right to payment from you for the full amount of each Charge subject to such right. We may deduct, recoup and offset such amount from payments to you or you shall pay us promptly upon receipt of our invoice, We shall have the right to Full. Recourse with respect to a Charge if you do not comply w,ith the terms of this Agreement, even if we had notice wnen we paid you for that Charge that you did not so comply and even if you obtained Authorization for the Charge in question. We will also have other rights to Full Recourse as provided elsewhere in this Agreement. DISPUTED CHARGES If we contact you regarding a claim, complaint, or question about any Charge ("Disputed Charge") you must respond to us in writing within twenty-five (25) days after we contact you. We will have Full Recourse for the amount of the Disputed Charge if, by the end of that time period, you have not provided us with a written substantive response to our inquiry which enables us to resolve the ' dispute. If a Cardmember, despite your reply, continues to withhold payment for the Disputed Charge and the Cardmember has the right under applicable law to withhold such payment, we will have the right to Full Recourse for such Charge. CARD ACCEPTANCE PROCEDURES Procedures for Card acceptance are set forth below. You must comply with any changes in these procedures of which we notify you, In Person Charges For Charges made in person, you must: · Verify that the Card is not visibly altered or mutilated; · Ensure that the Card is being used within the valid dates shown on the face of the Card; · Verify that the Card is signed in the same name as the name embossed on the front of the Card; · Create a Charge Record as described below and ver- ify that the Cardmember's signature on the Charge Form reasonably matches the signature on the back of the Card; . · Obtain Authorization as described below. Other Charges For all other Charges, such as Charges made by mail, telephone or at unattended Establishments, you must: · Obtain Authorization as described below; and , 3 . Create a Charge Record as desc'ribed below, except with the words "Mail Order," "Telephone Order" or "Signature on File" on the Cardmember signature line. If the Card member, denies making or authorizing such a Charge and you have not obtained the Cardmember's signature for the Charge, we will have Full Recourse for such Charge, We will not have Full Recourse for such a Charge based upon a claim that the goods were not received if you have: 1) verified with us that the address to which the goods were shipped is the Cardmember's billing address; and 2) obtained a receipt signed by an authorized signer verifying the delivery of the goods to such address. Completing Charge Records For every Charge you must create or complete a record of Charge ("Charge Record") containing: 1) the Card account number and expiration date via an imprinter or Card swipe device; 2) the date the Charge was incurred; 3) the amount of the Charge, which must be the total purchase price of the goods or services purchased plus applicable taxes; 4) the Authorization approval code number; 5) an accept- able description of the goods or services purchased; 6) an imprint or other registration of your name, address and the Establishment Number we assigned; 7) the Cardmember's signature; and 8) the words "No Refunds" if you have a No Refund policy. Authorization You must obtain an authorization approval code number from us as described' below ("Authorization"). Each Authorization request must be for the total purchase price of the goods or services purchased plus applicable taxes. Authorization is not a guarantee that we will accept the Charge without Full Recourse, nor is it a guarantee that the person making the Charge is the Cardmember. You agree to obtain Authorization for every Charge regard- less of amount. If your terminal is unable to reach our com- puter authorization system for Authorization, you agree to obtain Authorization for all' Charges by calling us at our authorization telephone number. You shall be charged 65 cents for each Charge for which you request authorization by telephone. We retain the right to change the amount we charge to you for requesting Authorization by telephone at any time. However, if (1) you do not have an electronic authorization terminal and (2) you are submitting Charges for taxis (not including limousine or car service) or parking, then you are not required to obtain Authorization for those Charges smaller than your Floor Limit. The Floor Limit for taxis is $50 and the Floor Limit for parking lots is $75. We have the right to change, or eliminate, your Floor Limit, at any time. You must obtain Authorization for all Charges described in the section entitled "Other Charges" and for all Recurrent Billing Charges regardless of the Authorization method and the amount of the Charge. For Charges for goods or services which are shipped or provided more than thirty (30) days after the order is made, you must obtain ,Authorization for such Charge at the time the order is made and again immediately before you ship the goods or provide the services to the Cardmember. You must not attempt to avoid the Authorization require- ment by submitting two or more Charges for a single transaction. You may not obtain Authorization on behalf of any other entity. Credits When you give a refund for a purchase made with a Card, you must credit that Card account ("Credit"). You must create a record of Credit ("Credit Record") and submit the Credit to us within seven (7) calendar days of determining the Credit is due, We will deduct the full amount of the Credit, minus the applicable Discount, from your payment. If we are unable to deduct such amount, you must pay us promptly upon receipt of our invoice, You will issue Credits only for Charges made with the Card. You must not give a cash refund for goods or services purchased with the Card. Submission and Acceptance of Charges and Credits You shall submit all Charges to us within seven (7) days of the date they are incurred, provided, however, that you shall not submit any Charge until the goods or services purchased have been delivered to the Cardmember, You must submit Credits as described above in "Credits." Charges and Credits will be deemed accepted on a given business day if received and processed before our close of business for that day at the location we designate. You warrant that all indebtedness arising from Charges that you submit is genuine and free of any liens, claims or encumbrances. You acknowledge that you have no right to bill and/or collect from any Cardmember for any purchase made with the Card. When you submit Charges and Credits electronically ("Charge Data"), you must do so over communications lines or via magnetic tape in machine-readable format ("Transmission"). Even if you transmit Charge Data elec- tronically you must still complete and retain Charge Records and Credit Records, Inthe event you submit Charges and Credits on paper, you must submit Charge Records and Credit Records approved, by us in accordance with the instructions we provide. Transmissions must comply with the specifications we provide and must include a description of the goods or services purchased which is acceptable to us, At our request you. shall place additional, less or differently formatted information on Transmissions, We are not obligated to accept any Transmission that does not comply with our requirements, 4 Processors You may retain, at your expense, a third party approved by us ("Processor") for obtaining Authorizations and/or submitting Charges and Credits. You, and not American Express, are responsible for any errors, omissions, delays or expenses caused by your Processor, You must provide us with all information we request about your Processor and you must notify us promptly in writing if you change your Processor, Recurrent Billing If you offer automatic/recurrent billing for a series of separate purchases, Cardmembers must sign a consent form ("Consent Form") authorizing you to charge their Card accounts for specific amounts at specific times ("Recurrent Billing Charges"), You must obtain a Consent Form before submitting the first Recurrent Billing Charge. The Consent Form must include the Cardmember's name, Card account number and signature; the amount of each Recurrent Billing Charge; the frequency of such Recurrent Billing Charges; the date the Recurrent Billing Charges will begin and end; and a statement that the Car.omember may cancel the Consent Form at any time, You must retain Consent Forms for twenty-four (24) months from the date you submit the last Recurrent Billing Charge. Before submitting each Recurrent Billing Charge, you must obtain Authorization and create a Charge Record except with the words "Signature on File" on the Cardmember signature line, Document Retention You must retain the original Charge Record or Credit Record and all documents evidencing such transactions, or reproducible records thereof, for twenty-four (24) months from the date you submitted the Charge or the Credit to us, You must provide a copy of the Charge Record or Credit Record or other supporting documents to us within twenty-five (25) calendar days of our request. Refunds Your refund policy for purchases made with the Card must be at least as favorable as your refund policy for purchases made with other forms of payment. You must disclose your refund policy to Cardmembers at the time of the purchase and in a manner that complies with applicable law. PROHIBITED TRANSACTIONS You may not accept the Card for: · Capital obligations and/or extraordinary expenses, including penalties or fines of any kind, damages, losses or any other costs or fees that are beyond the normal basic fee for the goods or services provided; . Gambll'ng services,; gambli'ng chips or gambling credits; · Cash; · Goods which will be resold; · Leases of personal property for greater than four (4) months; · Purchase of aircraft; . Sales made under a different trade name or business affiliation than indicated on the first page of this Agreement; · Sales by third parties; or . Amounts which do not represent a bona fide sale of goods or services at your Establishment. RESERVE We may withhold payment from you if, in our reasonable business judgment, it is necessary to create a reserve as security for your obligations to us under this Agreement or any other agreement between you and us, We have the right to deduct from and recoup and offset against the reserve, amounts you owe us under this Agreement or any other agreement between you and us. We will notify you if we withhold payments, We may take other reasonable actions to protect our rights including, but not limited to, changing your speed or method of pay, exer- cising Full Recourse immediately for all Disputed Charges without first sending you an inquiry,. and/or charging you a fee for each Disputed Charge. CONFIDENTIALITY You shall keep confidential any information you receive from us that is not publicly available. You agree that the names, addresses and account num- bers of Cardmembers are the sole and exclusive property of American Express:' You must not use or disclose a . Cardmember's account number except as provided in this Agreement. TRADEMARKS AND SERVICE MARKS This Agreement does not give either party any righ.tsin the other party's name, logo, service marks, trademarks,trade names, taglines or any other proprietary designation ("Marks"). No use may be made of either party's Marks without the prior written permission of that party. Where you mention the Card as a payment method you must use our Marks, but only as described in our logo sheets. You 5 agree that we may list the name and address of you and your Establishment(s) in materials containing lists of establishments which accept the Card which we may publish from time to time. NOTICES Unless otherwise notified, you will send all notices to: American Express Travel Related Services Company, Inc. P.O. Box 53773 Phoenix, AZ 85072 AUn: SE Maintenance Unit INDEMNIFICATION You agree to indemnify and hold harmless us, our parent, subsidiaries, affiliates, licensees, successors and assigns from and against all damages, losses and expenses including, but not limited to, reasonable attorneys' fees and costs, arising from any suit or claim arising or alleged to have arisen out of: 1) any goods or services you sell; 2) the marketing of any goods or services you sell; 3) the negligent or wrongful performance of, or failure to per- form, by you, your agents and/or employees, any duties or obligations under this Agreement; 4) the violation or alleged violation by you, your agents and/or employees of any laws, regulations or rulings applicable to you; and 5) your breach of this Agreement. TERMINATING THIS AGREEMENT Either party can terminate this Agreement by sending written notice to the other party, The termination will be effective on the third business day after such notice is sent. You agree that this Agreement is a contract to extend financial accommodations and that if bankruptcy proceed- ings or similar proceedings are filed with respect to your business, this Agreement is automatically terminated, You must notify us immediately if any of the above events occur. Upon termination, you must: 1) remove all American Express identification and return our materials and equip- ment immediately; 2) submit any Charges incurred prior to the termination in accordance with this Agreement; and 3) submit any Credits relating to these Charges in accor- dance with this Agreement. Our rights under the sections entitled "Full Recourse," "Disputed Charges," "Reserve," "Confidentiality" and "Indemnification" shall survive termi- nation of this Agreement. .' .COMP~IANCE WITH LAWS You agree to comply with all laws, regulations and rules applicable to you. GOVERNING LAW This Agreement will be governed by and construed in accordance with the laws of the State of New York applic- able to agreements negotiated, executed and performed entirely within the State of New York. ASSIGNMENT You may not assign this Agreement. We may assign this Agreement to our parent, subsidiaries or affiliates. NO WAIVER Failure to enforce any term or condition of this Agreement shall not be a waiver of the right to later enforce such term or condition or any other term or condition of this Agreement. PROVISIONS APPLICABLE TO SPECIFIC INDUSTRIES If you are engaged in any of the following industries you must comply with the following applicable provisions. HEALTH CARE For services rendered or goods provided while a Card member is admitted as a patient at your Establishment, you may delay submitting Charges up to $1200 but not for longer than (30) days after the r< Cardmember is discharged, INSURANCE You may accept the Card for insurance premiums only at your Establishments in the United States. You must not accept the Optimasm Card for these Charges, LODGING Assured Reservations If you have elected to participate in the Assured Reservations program, you must accept the Card to reserve accommodations until the published check-out time on the day following the scheduled arrival date (Assured Reservations). For each Assured Reservation, you must confirm the reservation and record the Cardmember's name, address, Card account number and expiration date, When accepting an Assured Reservation, you must advise the Cardmember that, if the Cardmember does not claim the Assured Reservation, or cancel it within the time specified in your stated cancellation policy, the " 6 Cardmember may be charged for one night's lodging plus applicable taxes. If the Card member does not claim or cancel the Assured Reservation, and you decide to charge the one night's lodging, you must submit a com- pleted Charge Record with the words "Assured Reservations - No Show" on the Cardmember signature line or transmit the appropriate no-show description on the Charge Data. If the Cardmember cancels, you must provide the Cardmember with a cancellation number and maintain a record of such cancellation number and the date provided. Failure by you to comply with the above requirements will result in our exercising our right to Full Recourse if the No-Show Charge is disputed by the Cardmember. If you do not honor an Assured Reservation, you must: 1) pay for a one night stay at comparable accommoda- tions nearby; 2) pay for transportation to the alternate location; 3) pay for a three minute telephone call, if requested by the Cardmember; and 4) forward all com- munications to the alternate location. If your cancellation policies and practices result in a dis- proportionate number of disputes with respect to No- Show Charges, you agree to cooperate with us in efforts to reduce the number of such disputes. In the event that such efforts fail to reduce the number of such disputes, we reserve the right to exercise our right to Full Recourse immediately for all such disputes without first sending you an inquiry. CARDeposit<ID If you have elected to participate in the CARDeposit<ID pro- gram, to ,the extent you require room deposits you must accept the Card for payment of these deposits ("CAR Deposits"), Only Cardmembers with a billing address in the United States, Canada, Puerto Rico or the U.S. Virgin Islands may use the Card for the payment of CAR Deposits, A CAR Deposit may not exceed the cost of a fourteen (14) night stay plus applicable taxes. For each CAR Deposit, you must complete a Charge Record except with the word "CAR Deposit" on the Cardmember signature line, You must also indicate on the Charge Record the scheduled arrival date, Within three (3) business days from the date of the CAR Deposit Charge you must send the Cardmember written confirmation of the arrival and departure dates, the amount of the CARDeposit, a confirmation number and the cancellation policy, If a CAR Deposit is canceled, you must send a written can- cellation notice showing the cancellation number to the Cardmember within three (3) business days. If a refund is due, you must submit a Credit Record with the words "CAR Deposit Cancellation" on the Cardmember signature line. If an arrival date of a CAR Deposit is changed, you will send the Cardmember a written confirmation of the change within three (3) business days, Upan arrival the Cardmember must shaw the Card. If the Cardmember daes nat have the Card, ather identificatian must be shawn, If yau do. nat hanar a CARDepasit yau must: 1) issue a Credit far the CARDepasit; 2) pay far camparable accammadatians nearby far the duratian af the ariginal reservatian (nat to. exceed 14 nights) ar until the ariginal lacatian accammadatians are available, whichever accurs first; 3) pay far the Card member's transpartatian to. the alternate lacatian and far a return to. the ariginal lacatian ance each day until the ariginal accammadatians are available; and 4) pay far two. three-minute telephane c'alls far the Card member to. infarm af the alternate lacatian and to. advise af being maved back to. the ariginallacatian. Emergency Check-In If a Cardmember whase Card is last ar stalen requests check-in, yau must call aur tall-free autharizatian number, ask far an "Autharizer," request Autharizatian far an "Emergency Check-In" and fallaw the Autharizer's Instructians. Yau may then submit a Charge Recard far the approved amaunt with the wards "Emergency Check-In" under the Cardmember's signature. Check Cashing Yau must cash persanal checks up to. $250 per stay far Cardmembers who. are paying far their stay with the Card, subject to. cash availability. We will reimburse yau far checks which are returned to. yau unpaid if yau have' fallawed aur instructians, ) Pramatianal Materials Yau must display praminently American Express signs, decalsar ather identificatian, including aur "Take-One" cantainers filled with Card application forms, in all high traffic areas, such as frant desks, cashiers' lacatians and restaurants. Yau must also. put aur "In-Raam" applicatians an desk tops in at least 90% af yaur raams. MOTOR VEHICLE SALES We will accept Charges far the dawn payment ar the entire purchase price af new and used matar vehicles anly if: 1) yau provide a full warranty an the matar vehicle af at least ane year ar 12,000 miles; 2) yau transfer title and physical passessian af the matar vehicle to. the Cardmember; 3) the amaunt af the Charge daes nat exceed the tatal price af the matar vehicle after applicaqle discaunts, rebates, cash dawn payments, and trade-in values have been deducted; and 4) yau abtain Autharizatian far the entire amaunt af the Charge, Yau must nat accept the OptimasmCard far these Charges. If within ninety (90) days after delivery af the matar vehicle, the Cardmember refuses to. pay us due to. a dispute regardir.g the quality af the matar vehicle, we. will have Full Re::aurse far the Charge. We will nat exercise i. 7 aur rights af Full Recaurse until the Card member has returned the matar vehicle to. yau, PARKING When the number af parking days is agreed upan when the Card member leaves the matar vehicle with yau, yau must submit the Charge within seven (7) days af the first day af parking, . When yau ,pravide a parking pass valid far a pre- determined number af parking days, yau must submit the Charge within seven (7) days af praviding the pass to. the Card member. When the number af parking days is nat knawn when the Cardmember leaves the matar vehicle with yau, yau must nat submit the Charge until the last day af par~ing. TELECOMMUNICATIONS We will exercise Full Recaurse immediately far all Disputed Charges withaut first sending yau an inquiry. Far telephane call Charges, yau will furnish a camplete descriptian af each call to. the Cardmember, TIMESHARE Yau represent that far at least 2 years yau have been in the business af: 1) selling Timeshare Units; ar 2) listing Timeshare Units far sale, rental ar exchange. "Timeshare Unit" means the exclusive right to. accupy a unit in a real estate develapment lacated. in the United States,. U.S. Virgin Islands and Puerto. Rica far vacatian and resart use far a periad af time each year nat exceeding 4 weeks. Yau may accept the Card anly for: 1) no. mare than 20% af the purchase price af an awnership interest ar ather annual occupancy right in a Timeshare Unit; or 2) membership fees to. register ar list a Timeshare Unit for sale, rental ar exchange. Yau may not submit any Charges until yau have the irrevacable right to. retain the payment under applicable law and under a written agreement signed by the Cardmember, Yau may nat accept the Card far: 1) maintenance fees; 2) campground memberships; 3) recreatianal fees; ar 4) interests in real praperty ather than Timeshare Units, CHARITABLE DONATIONS . Yau represent that yau are a nan-prafit arganizatian incarparated ar registered as such under applicable law and recagnized by the U,S, Internal Revenue Service ("IRS") as an entity qualifying far tax exemptian under Sectian 501 af the IRS Cade (the "Cade"). Yau may accept the Card anly far charitable danatians: 1) which are 100% tax-deductible to. the payar as a charitable cantributian under the Cade; ar 2) which include the receipt af an item ar service af value (such as a meal ar 8 . admission to an event or other incentive) where at least 75% of the amount is tax-deductible to the payor as a charitable contribution under the Code. CHANGING THIS AGREEMENT We have the right to change this Agreement at any time, We will notify you of any change in writing at least ten (10) days in advance. If the changes are unacceptable to you, you may terminate this Agreement as described in the section entitled "Terminating This Agreement." ENTIRE AGREEMENT This Agreement is the entire agreement with respect to the subject matter hereof and supersedes any previous agreement with respect to the subject matter hereof. VERIFICATION OF INFORMATIONIINVESTIGATIVE CONSUMER REPORTS You represent and warrant that all statements contained on the first page of this Agreement and such other information you provide to us in connection with this Agreement are true, complete and correct. You understand and agree that an investigative or consumer report about the commercial and/or personal finances of you and each of your owners, officers, partners, proprietors and/or principals may be requested - from a consumer and/or credit reporting agency or other investigative agency in connection with this Agreement. AUTHORITY TO SIGN You represent that the individual who signs this Agreement has authority to sign and to bind you to the terms of the Agreement. You further represent that you have read it and kept a copy for your file. We represent that American Express Travel Related Services Company, Inc. is authorized to,sign and enter into the Agreement on its own behalf and on behalf of its subsidiaries, affiliates and licensees that issue Cards. American Express Travel Related Services Company, Inc. By'pJc~ David C. House President, Establishment Services . ~ :> , . .. ESA Short Setup Form Instructions Solid boxes denote required fields and must be completed for SE setup. Failure to provide complete and accurate information will result in automatic rejection, The following table outlines the required fields and other information: Section Field(s) Required Other Information Header Source Code Identifies the source of origination for the setup request (to be completed by HQ and/or Telemarketing). Header Order Number ESA internal order number (completed at HQ), Header AMEX SE Number Order # or AMEX SE # required (to be completed by HQ and/or Telemarketing). Header Must check one of the following: New SE New SE: SE does not currently accept AMEX (Must complete sections A-F) and ESA is either processing bankcard transactions for SE or SE is applying to process through ESA. Change of Processor SE is currently accepting AMEX and wants to (Must complete sections A&E) change processors. Paper to EDC Conversion SE is currently accepting AMEX and submits (Must complete sections A&E) on paper, however, wants to convert to EDC, Section A: Corporate Business Name If SE requires an alternate address, check SE Characteristics Street Address 1 the appropriate box and provide additional City, State, Zip, Phone address information. SIC Code or Industry Code Section B: None required Please provide information if available, Miscellaneous SE Information Section C: Authorized Signer Name of person responsible for account Corporate Officers/ Owners/ Title Title of authorized signer Company History Social Security Time w/ Present Owner Length of time under current ownership Affiliation: If affiliated with another business that currently accepts AMEX, enter affiliated AMEX SE #. If Multiple affiliated businesses or locations of the same business are being signed concurrently, enter the CAP location's Order # in the Affiliated Order # box for all businesses/locations, Section 0: Discount Rate Discount Data Estimated AMEX Annual Volume Estimated Average Ticket Pay Frequency (3, 15 or 30 day) Section E: Must check one of the following: Submission Elec Tran Auth Proc If Elec Tran Auth Proc chosen, must indicate type of terminal software (Le. Retail, Dining, Lodging, Service) and provide Processor # in the section that follows. AMEX Terminal Complete If AMEX Terminal chosen ADDENDUM: EDC through AMEXlPIP Term. Processor # Terminal Provider # . Processor 10 # . Descriptor (Prod/Svcs sold) . Required by some processors. Section F: Must check one of the following: Payment Method ACH: Checking or Savings If ACH, provide all bank information (Le, ABA#, DDA#, Name on Bank Acct, etc.) and statement cutoff day, the day of the month on which the statement will print to coincide with bank statements, Paper Check For further questions call 1-800-528-5200. Rev 08/01/96 PTD. 12/96 ./ ..,..~_...._-=-----~ -- .. AMERIG'.AN EXPRESS ;,EsA SETUP SHORT FORM ITDJ Source.Code SPID Order Number D New SE (A-F) r-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-' I I I I I' 1 1 -I 1 I I 1 I I I 1 I I 1 I I I , 1 I I 1 1 1 I I I I , I I 1 I I I I I ~-~-~-~-~_._~_._._._~_._~_.-.-~-~-~-.-~-~ r-T-T-T-T-T-T-T-.-T-' I I , I I I f I I I I I I I I I I I I I I I ~-~-~-~-~-~-~_._._~-~ Mail: '661 E, Camelback Rd, Altn: ESAP Phoenix, {>;Z 85016 Info: 1-800-528-5200 Fax: 1-602-234-7111 OR AM EX SE # D Change of Processor (A& E) o Paper to EDC Conversion (A & E) A Corporate Business Name .................................................... , . tn~~:~".:~:'1 Doing Business As (DBA) r-.-T-,-T-T-T-T-T-T-T-T-T-,-T-T-T-T-,-,-T-,-T-T-T-' I I I I I I I I I I I I I 1 I I I I I I I I , I I I I I 1 I t I I 1 1 1 I I I 1 1 I I I , 1 t I 1 I 1 1 ~_._~-~_._~_._~_.~._~-~-~-~-~_.-._~_._.-~-~-~_._~-~ Street Address1 (no PO box) Street Address2 (no PO box) r-,-,-,-T-,-,-,-T-T-T-T-T-T-T-T-T-,-,-T-T-T-,-T-T-' , 1 I 1 1 , 1 I I , , 1 1 I 1 1 1 1 1 1 , 1 1 I 1 I I 1 I 1 I 1 I I 1 1 I 1 1 I 1 I 1 I I I I 1 I I I 1 ~_._._~_._._~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~-~ City rn 0llIJ "'-T-T-T-T-T-" I I I I I I I ST Zi _, I I I I I , P ~_~_~_~_~_~_~ Phone # . Additional Address(es): (Select items to be sent to alternate address.) D Payment Address 0 Correspondence Address [ill [ill- ITDJ E~. r-T-T-T-' I 1 1 I I I 1 1 I I ~_..L;..~_~.;.~ SIC Code ITDJ OR r-T-,-' I 1 I I Ind Code ~ _..:.. _..:.. _ ~ o Marketing Material Address Name r-T-T-,-T-,-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-' I I I I I I 1 I I I I I I 1 I I I' I I I I I 1 1 I I I I I I I I I I 1 I 1 I 1 I I I 1 I I I I 1 I I 1 I ~_~_~_..L_..L_~_~_..L_~_..L_..L_..L_~_..L_..L_~_~_..L_~_..L_..L_..L_..L_..L_~_~ r-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-,-T-T-T-' I I I I 1 I I 1 I I t 1 1 I 1 I I 1 1 1 I I I I I I I I 1 I 1 I I I I I I 1 I I I I I 1 I I I I 1 1 I , ~_..L_..L_..L_..L_~_..L_~_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_~_..L_..L_~ St. Address .1 St. Address 2 r-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-T-.-, I 1 I I 1 I 1 1 I 1 I 1 I I , 1 I I I I 1 1 I 1 1 I I I I I 1 1 1 1 I I I 1 I It' 1 1 I I I I I I , I ~_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_~_..L_..L_..L_..L_..L_..L_..L_..L_..L_..L_~ r-T-' r-T-T-' I I I I .1 1 I DUN'S #: ~ _1-_ J ~ ~ _..:.. _l_ J r-T-T-,-' I I I 1 I I I I I I ~_..L_..L_..L_~ r -,- ,-, - ,- T- T -, - ,- T- ,- T-,- T-. - ,-. -. -, -,-.-. -,-'I - T -, r-T-' r - ,-, -, -, -, r-.- 'I - T - T -.-, I I I I 1 I I 1 I 1 I 1 1 I 1 1 I I I I I I 1 1 I 1 I I I I I I I , I I , I I I I I ~ _.1. _.1. _.1. _.1. _l_.1.._l_l_ ..:.. _..:.. _.l. _.l. _ ..:.. _.l. _ ..:.. _..:.. _ ..:.. _..:.. _ '..:.. _.1.. _ ..:.. _ ..:.. _..:.. _..:.. _ J ST ~ _.1.. _ J Zip:" _.1. _.1. _.1. _ ..:.. _ J . ~ _ ..:.. _..:.. _1-_.1. _ ..:.. _ J Site Inspection: c=~ Yes c=~ No # EmployeeslSE c=r=r=r r=~ MailOrder%C=r=~ Seasonal: From Month c=r=~ ToMonth i-r-~ Corporate Officers/Owners/Company History Title Auth. Sig. Social Security # [ill rn ITDJ r-., r-' r-' r--:l r-' I I' I I I I I 1 I I Affiliation? Yes ~ _ ~ No~ _ ~ Ownership Type: ~ _ ~ Corporation ~ _ ~ Partnership ~ _ ~ Sole proprietor ~ _ ~ Franchise r-T-,-T-T-T-T-T-T-,-T-.-T-T-T-T-T-T-T-T-' I I I I I I I I I I I I I I I , I I I , I Affiliated Order # ~ _l_ ..:.. _ ..:.. _1-_ ..:.. _ ..:.. _ ..:.. _ ..:.. _ ..:.. _1-_ ..:.. _ ..:.. _ ..:.. _ .:.. _ ..:.. _ ..:.. _ ..:.. _1. _ ..:.. _ J Time at curr~nt location rn rn Date Estab. : - T -: : - T - : ~_..L_~ ~_~_~ , Years & Months Month Year ~ Submission: (Check the sUbmissl~n method below) j-T-T-T-T-T-T-,-T-T-' I I 1 I 1 I I 1 , I I Affiliated AMEX SE #:.. _..:.._..:.. _..:.. _..:.. _..:.. _..:.. _..:.. _..:.. _..:.. _ ~ r-T-,-T-.-T-T-T-T-T-T-T-T-T-T-' 1 I I , I I I I I I 1 1 I I 1 I CM#~_":"_l_l_l_":"_":"._":"_":"_1-_":"_l_l_l_l_J m Discount Data. AMEX Discount Rate [[[]] D Elec Tran Auth Proc" D Reverse PIP" D AM EX Terminal Complete Addendum D Paper Est. Volume $ (AMEX Annual) Term Software: D Retail D Dining D Lodg D Service # of Terminals. ITIJ Estimated Average Ticket D 3 Day D 15 Day D 30 Day ", please complete section below: Processor # Pay Freq,: Term Prov # Processor 10# Descriptor (Prod/Svcs sold) F Payment Method (Bank reference name other than transaction account) ACH: Checking 0 or Savings D Statement Cutoff Day of Month ACH ABA # rnrrITDJ Paper Check D Bank Name ~ . _ ::' r:-- Bi ancp A"1ress City . _\~~:. ~t:~:"7 rnl.:~~"~~?7:7~~:._;~;':lt~~~~~~~~~~~~~Je5~_;r~"~~~~~~.~,"_,