Merchant Application and Agreement

SecureNet Use Only

Merchant ID:

Account Executive Name:

MCC:

BIN:

City

State

Tax ID #

Business Start Date (MM/YYYY)

Merchant Information
Business Legal Name
Business Legal Address (No P.O. Boxes)
Telephone Number

Fax Number (for chargeback notifications)

Merchant Doing Business As Name (max. 23 characters, including spaces)

How Long at This Location?

Location Address (No P.O. Boxes)

City

Customer Service Telephone Number

Primary Merchant Contact Name

State

Zip

E-Mail Address (for Merchant Account correspondence)

Company Website URL

Describe Merchandise Sold or Services Provided

Type of Ownership: Sole Proprietor

Type of Business: Retail

Zip

Partnership

Restaurant

LLC

Public Corporation

Mail/Telephone Order

e-Commerce

Private Corporation
Business-to-Business

Government
Medical

Non-Profit
Lodging

Petroleum

Petroleum w/Store

Services Applying For

Visa/MasterCard/Discover

American Express + Existing AmEx Merchant Number, If Any:

PIN Debit

Owners/Officers (List the owners with the largest share of ownership. Individual or combined ownership must equal at least 50%. The owners listed must sign page 2 of this document.)
1. Name

Title

Percent Ownership

Residence Address

City

State

Telephone Number

SSN

Date of Birth

Zip

Drivers License #

Issuing State

2. Name

Title

Percent Ownership

Residence Address

City

State

Telephone Number

SSN

Date of Birth

Zip

Drivers License #

Issuing State

Bank Information - Deposits (Please attach pre-printed, voided check or bank letter.)
Bank Name

Transit Routing Number

Account Number

Address

City

State

Contact

Telephone Number

Fax Number

Bank Name

Transit Routing Number

Account Number

Address

City

State

Contact

Telephone Number

Fax Number

Zip

Bank Information - Debits (Please attach pre-printed, voided check or bank letter.)

Zip

Underwriting Profile
Total Annual Sales Volume (Credit, Debt, Check & Cash)

Average Ticket (Credit & Debit Card Transactions)

Total Annual Sales Volume (Credit & Debit Card Only)

High Ticket (Credit & Debit Card Transactions)

Average Monthly Sales Volume (Credit & Debit Card Only)

Average Number of Transactions Per Month

% of Card Sales Generated By:

% Card-Present (Card Swiped)

% Card-Present (Manual Entry)

% Card-Not-Present (MO/TO)

% e-Commerce (Internet)

Is your business seasonal? Yes No

High Volume Month(s): January February March April May June July August September October November December

Delivery, Refund & Sales Policy

From date of charge, products are delivered in:

% 0-7 Days

% 8-14 Days

% 15-30 Days

Do you have a refund policy for your Visa/Mastercard/Discover Sales? No Yes

If Yes, please specify the refund policy: Exchange Store Credit Credit Card Refund Cash Back Other
If Credit Card Refund, within how many days do you refund transactions? Same Day 1-2 Days 3+ Days

SecureNet Payment Systems

% 30+ Days
Are customers required to provide a deposit? No Yes
If Yes, what percent of the total sale is required?

Form No. 1024 (Rev. 3 - June 17, 2011)

Terms & Conditions

THIS MERCHANT APPLICATION AND AGREEMENT (this Agreement) is entered into by and between SecureNet LLC., a limited liability company, on its own behalf and as agent for Bank
and the Merchant identified in this Agreement. Under the Terms and Conditions of this Agreement, SecureNet will be the sole provider to the Merchant of the services necessary to authorize,
process, and settle all of the Merchants credit and debit card transactions set forth in Schedule A of this Agreement. If a third party referred you to SecureNet for the services provided under
this Agreement, such third party may be a party to the Agreement, but has no rights with respect to the Merchant except as provided in such third partys agreement with SecureNet.
FOR MERCHANT AND INDIVIDUAL GUARANTORS As the person signing below on behalf of the business designated on the above Application (Merchant), I certify that I am an owner,
partner, or officer of the Merchant and have been duly authorized to sign this Merchant Application and Agreement on behalf of the Merchant. Merchant and each guarantor signing below
(Guarantor) hereby acknowledge that they have each received and read (1) the Terms and Conditions for this Merchant Application and Agreement, (2) the Schedule A (pricing), and (3)
the Merchant Services Operating Procedures. Merchant agrees to be bound by the terms and conditions contained in those documents, and each Guarantor hereby agrees to be bound as a
Guarantor of the Merchants obligations under this Agreement, according to the Personal Guaranty contained in the Terms and Conditions for Merchant Application and Agreement. Merchant
hereby authorizes SecureNet to credit and debit Merchants designated bank account(s) in accordance with this Agreement. Merchant represents and warrants that all information on this
Application, and the related information submitted in conjunction with the Application, is true, complete, and not misleading. The Application now belongs to SecureNet. Merchant understands
that the application fee is non-refundable. Merchant, each Owner/Officer, and each Guarantor hereby authorizes and agrees that SecureNet, or its designee, may investigate and verify the
credit and financial information of Merchant, each Owner/Officer, and any individual Guarantor and may obtain consumer and commercial credit reports on the Guarantors, Owners/Officers, and
Merchant from time to time. If the Application is approved, subsequent consumer and business credit reports may be required or used in connection with the maintenance, updating, renewal, or
extension of the Agreement. The Merchant, Owners/Officers, and each Guarantor agrees that all business references, including banks, may release any and all credit and financial information
to SecureNet.
ANY UNILATERAL ALTERATION, STRIKEOVER OR MODIFICATION TO THE PREPRINTED TEXT OR LINE ENTRIES OF THIS MERCHANT APPLICATION AND LEGAL AGREEMENT
SHALL BE OF NO EFFECT WHATSOEVER, AND AT SECURENETS SOLE DISCRETION, MAY RENDER THIS MERCHANT APPLICATION AND AGREEMENT INVALID.
By signing below, I agree to adhere to the SecureNet Terms and Conditions as well as the Merchant Services Operating Guides and/or Operating Procedures as set forth at
http://www.securenet.com/index.php/documents as such may be hereafter amended, modified or updated. Should I have any questions regarding these documents and the information
contained therein, I may contact my SecureNet Account Executive or I may contact SecureNet directly.

Bank Information and Merchant Responsibilities Disclosure

Member Bank (Acquirer) Information
EagleBank
7815 Woodmont Avenue, Bethesda, MD 20814
Phone: (240) 497-2044
Fax: (301) 986-8529
Important Merchant Responsibilities
1.
Ensure compliance with cardholder data security and storage requirements.
2.
Maintain fraud and chargebacks below thresholds.
3.
Review and understand the terms and conditions of the Merchant Application and Agreement.
4.
Comply with Visa, MasterCard, and Discover Operating Regulations as detailed in the Merchant Services Operating Procedures found at http://www.securenet.com/index.php/documents.
The responsibilities listed above do not supersede terms of the Merchant Application and Agreement and are provided to ensure the Merchant understands the important obligations of each
party and that the Member Bank is the ultimate authority regarding the Merchant Account. SecureNet is here to provide you with all the tools and information necessary to meet the standards of
card processing and provide you with the education needed to stay compliant with the rules and regulations set forth by Visa U.S.A., MasterCard International and DFS Services LLC (Discover).
By signing below, I agree that I have received a copy of the Terms and Conditions of this Merchant Application and Agreement along with a copy of the Merchant Operating Guide. I agree to adhere
to all of the guidelines outlined in the Terms and Conditions for Merchants and all of the transaction rules outlined in the Merchant Operating Guide as such may be hereafter amended, modified
or updated. I agree that SecureNet may change Member Bank at its sole discretion. Should I have any questions regarding these documents and the information contained within, I may contact
my SecureNet Account Executive or I may contact SecureNet directly at (301) 231-0000.

Signatures
Business Legal Name

Merchant "Doing Business As" Name (Max. 23 characters, including spaces)

OWNER/OFFICER 1

OWNER/OFFICER 2

By:

By:

Signature (#1 from application)

Date

Signature (#1 from application)

Print Name & Title

Date

Print Name & Title

Personal Guarantee: The undersigned guarantees to SecureNet LLC and Member Bank the performance of this Merchant Application and Agreement and any addendum thereto by Merchant,
including payment of all sums due associated with enforcement of the Terms and Conditions thereof. SecureNet LLC and Member Bank shall not be required to first proceed against Merchant or
enforce any other remedy before proceeding against the undersigned individual. This is a continuing guarantee and shall not be discharged or affected by the death of the undersigned and shall
bind the heirs, administrators, and representatives and be enforced by or for the benefit of any successor of SecureNet LLC and Member Bank. The term of this guarantee shall be for the duration
of the Merchant Application and Agreement and any addendum thereto, and shall guarantee all obligations which may arise or occur in connection with the Merchant activities during the term
thereof through enforcement shall be sought subsequent to any termination.
OWNER/OFFICER GUARANTOR 1

OWNER/OFFICER GUARANTOR 2

By:
Signature (#1 from application)
Print Name & Title

SecureNet Payment Systems

By:
Date

Signature (#1 from application)

Date

Print Name & Title

Form No. 1024 (Rev. 3 - June 17, 2011)