HomeMy WebLinkAboutInvoice Cloud 2022-03-03Page 1 of 5 Rev. 2020-NOVNew Division Boarding Form_GBL_US/CA_CR420_Nov
Merchant Services l 8181 Communication Pkwy, Bldg A, Floor 03, Plano, TX, 75024 l chase.com/merchantservices
l Toll Free Phone (866) 428-4962 l PTI-NPS@chase.com
U.S. and Canadian New Division Boarding Form
Note: This is an interactive form that will render based on selections within the document. Please fill out completely (top to bottom) before printing and signing.
Company ID #
63576
Company Legal Name
Invoice Cloud, Inc.
Projected Live Date
3/1/2022
1. Company Information
Transactions processed for this new set up request belong to:
Merchant whose company legal name is represented above An Additional Company whose legal name is...
City of Ukiah
and is a
affiliate
of the merchant noted above.
On behalf of...
Company Legal Name
Invoice Cloud, Inc.
1b. Taxpayer ID (W-9 required if new U.S. entity and/or taxpayer ID. W-8 required for Canadian entities)
Transaction Division's Taxpayer ID
94-6000446
Legal Entity Name
City of Ukiah
Are you tax exempt under Internal Revenue Code Section 501(c)(3)?
(Required for US clients only)Yes No
1c. 1099K Contact Information (Required for new U.S. Taxpayer ID's)
1099K Contact Name (Contact to receive 1099K supplied on W-9)
Mary Horger
E-mail Address
mhorger@cityofukiah.com
2. Report Center and Transaction History Contacts
Item Name E-mail Phone #Address City State/Prov Zip/Postal
Code Country
1 Thomas Griffin tgriffin@invoicecloud.com (781) 654-0474 30 Braintree Hill Ste 303 Braintree MA 02184 USA X
Select access required: Transaction History Report Center Both Existing User ID:
Add User
3. Chargeback Contacts
IQA (Manager/Supervisor - one who assigns work to MCA)
MRQA (Manager/Supervisor - one who assigns work to MRA)
Note: This is the contact that will receive any documents that need to be mailed and/or faxed.
Item Name E-mail Phone #Address City State/Prov Zip/Postal
Code Country
1 Barbara Chestna bchestna@invoicecloud.com (781) 353-2415 30 Braintree Hill Ste 303 Braintree MA 02184 USA X
Does this User require access to: Report Center
Click here to add or copy line item from this table Click here to copy line item from section 2 - Report Center
Page 2 of 5 Rev. 2020-NOVNew Division Boarding Form_GBL_US/CA_CR420_Nov
MCA (Merchant Chargeback Analyst - one who works the chargebacks)
MRA (Merchant Retrieval Analyst - one who works the retrievals)
Item Name E-mail Phone #Address City State/Prov Zip/Postal
Code Country
1 Barbara Chestna bchestna@invoicecloud.com (781) 353-2415 30 Braintree Hill Ste 303 Braintree MA 02184 USA X
Does this User require access to: Report Center
Click here to add or copy line item from this table Click here to copy line item from section 2 - Report Center
4. Bank Account Information
Existing Bank Account Information
Will you be depositing funds into an existing Funds Transfer Instruction (FTI)?No
Is this a bank account we are currently funding?No
New Bank Account Information
SETTLEMENT CURRENCY
(in which we will fund to you)COUNTRY WHERE BANK ACCOUNT RESIDES
USD (US Dollar)US Canada International
Section A: U.S. Bank Account Information ACH
ABA #
123205054
Division is located outside of the U.S. or Canada and is
settling funds in USD and will be the method of transfer as
a default
Bank Account #
10604605
Bank Account Name
City of Ukiah
Financial Institution Name
Umpqua Bank
City
Ukiah
State/Prov
CA
Zip/Postal Code
95482
Country
USA
Checking Savings
Note: If this request relates to an account not held at JPMorgan Chase Bank, please attach an
original voided check (starter checks are not accepted) or a bank letter of verification. JPMorgan
Chase bank accounts do not require validation documentation.
ACH Debit Allowed - Your bank account must support ACH debit.
If not, you must provide this Chase ACH debit block # to your bank - 1020401225
5. Business Unit (if different from division name)
Parent Business Unit Name (if applicable)Parent Business Unit # (if applicable)
Business Unit Name City of Ukiah Business Unit #
I have a "Business Unit" Financial Contact that is not an existing "Company" Financial Contact
6. Transaction Division Information
Page 3 of 5 Rev. 2020-NOVNew Division Boarding Form_GBL_US/CA_CR420_Nov
6. Transaction Division Information
Transaction Division Name (30 character limit)
2961 City of Ukiah-Recreation
Settlement Currency
USD (US Dollar)
Presentment Currency
U.S. Dollars (USD)
Division Location Street Address (must be a street address, P.O. Boxes not acceptable)
300 Seminary Avenue
City
Ukiah
State/Prov
CA
Zip/Postal Code
95482
Country
USA
How will you process?Retail MOTO (Mail/Telephone)Internet/eCommerce
Cardholder Descriptor
Where would you like asterisk (*) placed?4th Position 8th Position 13th Position None
City of Ukiah
Customer Service Phone #URL (Optional if phone # is provided)
(707) 463-6295
Products/Service Description (ex. clothing, books, membership, etc.)
Recreat ion
Maximum Sales Transaction Amount USD
$125,000.00
Maximum Refund Transaction Amount USD
$25,000.00
(Default $25,000 USD or equivalent
"international" currency per transaction)
If >$25,000 please provide an invoice.
Avg. Transaction Price
$253.00
Avg. # Trans. Per Year (settled Only)
355
Projected Refund %
5.0%
Customer's Payment Option
Single Payment Bill Payment
6b. Internet Transactions
Full website address:www.invoicecloud.com/CityofUkiah
Encryption (select all that apply)SSL SET No encryption
Can an order be placed and credit card info given via this website? Yes No
Is the website secure so not to be read or intercepted by others? Yes No
6c. Profile - billing & delivery of goods and services
Do you stock products?Yes No Do you fill your own orders?Yes No
Do you own product at time of sale?Yes No
Do you provide customer orders at time sale?Yes No
Do you drop ship the product?Yes No
When will you charge for an order?Bill after Shipment
7. Products and Services
Page 4 of 5 Rev. 2020-NOVNew Division Boarding Form_GBL_US/CA_CR420_Nov
7. Products and Services
Account Updater
MC SecureCode
MCID - MasterCard Assigned ID
Authorization Recycling
8. Methods of Payment Note: You must make a selection in Section 4 for this section to populate.
Please indicate if you will be using any of the following card type/methods of payment. Please note that some of these services may require an additional
contract amendment, pricing and/or information if you currently do not have the service.
Visa MasterCard Discover (settled) Discover Diners JCB As a default Discover (settled), Discover Diners and JCB will be
enabled whenever Visa and MC are enabled.
Discover (conveyed)Discover SE#
American Express Opt Blue (Enabled for those merchants who have Opted in and meet the qualifications (U.S. only)
American Express (conveyed)Service Establishment # (SE#)
Amex Cardholder Descriptor City of Ukiah Recrea
TAA #1
TAA #2
TAA #3
TAA #4
Do you support American Express Partial Authorization?
(select if applicable)
How have you been classified as a merchant by American Express?
(select if applicable)
PINless Debit (non Retail)
PIN Based Debit (Retail) Division will be setup with the following network vendors (Pulse, NYCE, STAR, Interlink, Maestro, ACCEL, Jeanie, AFFN and CU24)
Electronic Check Processing Company Name City of Ukiah
Item Description Recreat ion
Preferred Delivery
Best Possible (U.S. Only)
How do you obtain authorization?
Internet (U.S.Only)
If no amounts provided, default will
match credit card transaction amount.
ECP Maximum Sale Amount USD
$125,000.00
ECP Maximum Refund Amount USD
$25,000.00
If not selected, no redeposit event will
be attempted Smart ECP Redeposit Opt In
9. Processing Methods
Who will be submitting transactions to Chase Merchant Services and what product will they be using?
Page 5 of 5 Rev. 2020-NOVNew Division Boarding Form_GBL_US/CA_CR420_Nov
9. Processing Methods
Presenter Submitter Name
Invoice Cloud
Submitter # (SU)
411744
Presenter ID # (PID)
NetConnect Batch and/or Online Authorization Orbital Payment Gateway Online POS Terminal (OPT)
Orbital Payment Gateway
Primary Contact (must be a contact at the company)
Tony Cordova
E-mail Address
tcordova@invoicecloud.com
Address
624 E Washington St
Phone #
City
Brownsville
State/Prov
TX
Zip/Postal Code
78520
Country
USA
Primary Contact Level of access Merchant Chain
Auto-Settle Information
Select None for no auto settlement time.
Auto-settle Time AM/PM Time Zone
Eastern
Profile Management required?None Merchant Chain Hosted PayPage (HPP)
10. Terminal , Software and PIN Based Debit (please select what you will be utilizing)
Point-of-sale Software (VAR)Equipment/Terminal PIN Pad (Retail Only)
Kits and Imprinters
Overlay, Quick Reference Guide, etc.Sales Drafts, Credit Drafts, etc.Imprinter Plate Imprinter (default is None)
11. Signature
Print Name
Sage Sangiacomo
Title
City Manager
I represent and warrant: (a) I am duly authorized by Merchant to submit the information provided herein and execute this document on behalf of Merchant; (b) I am duly
authorized to provide the banking information set forth herein for the purposes outlined, including the transfer of funds; (c) I am duly authorized to grant access to the
information contained and outlined herein to all contacts listed throughout the document; and (d) all information provided herein on behalf of Merchant is true and accurate.
Signature Date
Signer's name must be a company Executive or Financial Contact.
**In order for us to settle funds in accordance with the banking details supplied herein, you are responsible for providing true, accurate, current and complete information
regarding your banking details, and we are not responsible for errors or omissions in the information that you provide. In the event that any banking details provided by you
are incomplete, not current, or inaccurate, you agree that we may request, obtain and use credit or any other reports/information from third party sources to complete such
banking details necessary for us to settle funds with you. You further agree that we are not responsible and shall not be liable in any way for any delay or failure to settle funds
with you or for any error in your settlement account if the banking details/information provided by you or by third party sources is false, incomplete, not current or inaccurate.
Mar 3, 2022