HomeMy WebLinkAboutInvoice Cloud 2021-10-14; Amendment 2 2025-09-04Add-On to the Biller Order Form
SALES INFORMATION
IC Sales Rep Christina Pavlov Vertical Utility
Order Date 9/4/2025 Sales Partner MilSoft Utility Solutions Software Partner MilSoft Utility Solutions
PRODUCTS AND SERVICES
Products [EBPP]
PAYMENT METHODS ACCEPTED
Payment Types [American Express] [VISA/Mastercard/Discover] [PayPal] [ACH/EFT]cpavlov@invoicecloud.com
BILLER INFORMATION
Ownership Type Government Phone (707) 463-6295 Fax (707) 463-6740
Legal Name City of Ukiah Website URL http://cityofukiah.com/
Address 1 300 Seminary Avenue Bus. Open Date 3/8/1876
Address 2 Federal Tax ID 94-6000446
City Ukiah *Federal Tax ID and Legal Name must match on all documents
State CA ZIP 95482 Array
BILLER CONTACT
Primary Contact Name Mary Horger
Phone 7074636233
Email Address mhorger@cityofukiah.com
SIGNING AUTHORITY
Name Sage Sangiacomo Title City Manager
Phone 7074636217 Fax (707) 463-6740 Email Address ssangiacomo@cityofukiah.com
BILLER PRICING
Description Interval Cost Type Cost
Biller Portal Access Fee Monthly Fixed ($) $285.00
HARDWARE
Card Reader Type Quantity Cost per Reader
Card Reader Billing Interval Monthly
Shipping Addr.
(if different than
location address)
Kiosk Type Device Quantity Per Device Txn Min Note: Biller will be charged for the minimum number of transactions listed to left each
Standard/In-Door 750 month per kiosk unity. In addition, if the Biller's order includes kiosks then the terms
Thru-Wall 800 and conditions of Kiosk Managed Standard SOW (and applicable schedules) are hereby
Outdoor Model 850 agreed and incorporated by reference
BILLER BANK INFO
Note: Must include voided business check or bank letter for each unique account
Billing Method Direct Debit
Name on Account Bank Name
Bank Address Phone
Routing # Last 4 Acct #
COU No. 2122-104-A2
DATA RETENTION
Months to Keep 24 *Additional Fees apply if greater than 24 months
NOTES/SPECIAL HANDLING
Biller currently has an existing Biller Portal Access fee of $450 is for City of Ukiah, Millview County Water District, Redwood Valley County
Water District and is adding Willow Country Water District to this fee.
The new $285 Biller Portal Access Fee is for the new invoice types: Calpella, Hopland and River Estates.
CERTIFICATION AND AGREEMENT
A.By signing below, the Biller hereby ratifies its authorization for Invoice Cloud, Inc. ("Invoice Cloud") to execute debit/credit entries to its checking/deposit account(s)
indicated above at the depository financial institution(s) named above and to debit/credit the same such account(s). The Biller acknowledges that the origination of
ACH transactions to its account(s) must comply with the provisions of U.S. law. This authority is to remain in full force and effect until (i) Invoice Cloud has received
written notification (by electronic or U.S. mail) from the Biller of its revocation in such time and manner as to allow Invoice Cloud a reasonable opportunity to act on
it, but not less than 10 business days notice; and (ii) all obligations of the Biller to Invoice Cloud that have arisen under this Agreement and all other agreements have
been paid in full. The Biller must also notify Invoice Cloud, in writing, (by electronic or U.S. mail) when a change in account number(s) or bank has occurred at which
time this authorization shall apply to such new/changed account. This notification must be received within 10 business days of change. A fee will be charged for any
returned ACH debits.
B.By signing below, the Biller named: (1) has read, agreed to, ratifies the Biller Agreement, Biller T+C and other Order Forms previously executed by the Biller, and (2)
certifies to Invoice Cloud that he/she is authorized to sign this Add on to the Biller Order Form; (3) certifies that all information and documents submitted in
connection with this Order Form are true and complete; (4) authorizes Invoice Cloud or its agent to verify any of the information given, including credit references,
and to obtain credit reports (including a spouse if in a community property state); (5) agrees to pay the Monthly Access Fee through the last day of the month
following the effective date of termination as provided in the Billing Agreement; (6) agrees that Biller and each transaction submitted will continue to be bound by
the Order Form and the Biller Agreement in its entirety and any new agreement forms executed herewith; (7) If the Biller's order includes kiosks, then the terms and
conditions of Kiosk Managed Services Standard SOW (and applicable schedules) are hereby agreed and incorporated by reference.(8) agrees that Biller will submit
transactions only in accordance with the information in this Add on to the Biller Order Form and Biller Agreement and will immediately inform Invoice Cloud, by email
(contracts@invoicecloud.com) if any information in this Order Form changes, and (9) the Biller agrees and understands that outstanding sums due and owing to
Invoice Cloud., will be charged daily or monthly and debited from its current depository account. Non-sufficient funds for these debits are grounds for a change in
fees or termination of this Agreement. In the event of non-payment of any sums due, Invoice Cloud reserves the right to withdraw such sums from the current
depository account at any time to ensure payment of the same.
C.Pay by Text: Standard data rates and text messaging rates may apply based on the payer's plan with their mobile phone carrier. Payer can opt out of text messaging
at any time with Invoice Cloud. Partial payment or overpayment is not supported. Service fees may apply based on the biller set up with Invoice Cloud. Biller may not
use the service for activities that violate any law, statute, ordinance or regulation.
D.By signing below, the Biller hereby gives permission to Invoice Cloud to access his / her credit history via Trans Union, Equifax, or other credit-reporting agency.
E.This Add on to the Order Form will become effective only when counter-signed by Invoice Cloud and upon execution by the Biller of such third party agreement
required by Invoice Cloud to permit use of the payment function of the Service.
F.If the Biller's order includes kiosks, then the terms and conditions of Kiosk Managed Services Standard SOW (and applicable schedules) are hereby agreed and
incorporated by reference.
In WITNESS WHEREOF, the parties have executed this Agreement as of this day
Accepted by Biller: Accepted by Invoice Cloud, Inc.:
X X
Corporate Officer Corporate Officer
Sage Sangiacomo Kevin W. O'Brien
Printed Name Printed Name
City Manager CEO
Title Title
September 9, 2025.
Biller Order Form
BILLER ORDER FORM
INVOICE TYPE PARAMETER SHEET
Invoice Type Parameters must be completed for each invoice type
Invoice Type Willow County Water District Pricing Model Non-Submitter
Christina Pavlovcpavlov@invoicecloud.comBiller Pays Network Fees Yes
CURRENT BILLING DETAILS
Please indicate how many bills are sent monthly by placing the bill count for each month below:
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
250 250 250 250 250 250 250 250 250 250 250 250
Avg CC
Transaction $ 65.00 Max Invoice $ 81.00 Bill Frequency Monthly Avg. Bills Per
Month 250
PRODUCTS AND SERVICES
Products and Services [EBPP]
TRANSACTIONAL PRICING (Paid by Biller)
Payment Source Description Payment Method Fee Rate % Fee Amount $ Additional Fee $
All Payment Sources Credit/Debit/PayPal .5% $0.40
All Payment Sources ACH/EFT $0.75
TRANSACTIONAL PRICING EXCEPTIONS
SERVICE FEES (Paid by Payer)
Payment Source Description Payment Method Fee Amount Calculation
Type Min. Fee ($) per Transaction
All Payment Sources Credit/Debit/PayPal
All Payment Sources ACH/EFT
IVR Surcharge All Payment Methods
SERVICE FEE EXCEPTIONS
MAX PAYMENT CAP
Card and PayPal Max ($) 125,000 ACH Max ($) 125,000
BILLER BANK ACCOUNT (FOR DEPOSITS AND CHARGEBACKS)
Note: must include voided business check or bank letter for each unique account
Routing # Last 4 Acct # Last 4 Acct # for OBD
NOTES / SPECIAL HANDLING
Biller Order Form
Biller Order Form
BILLER ORDER FORM
INVOICE TYPE PARAMETER SHEET
Invoice Type Parameters must be completed for each invoice type
Invoice Type Hopland Pricing Model Non-Submitter
Christina Pavlovcpavlov@invoicecloud.comBiller Pays Network Fees Yes
CURRENT BILLING DETAILS
Please indicate how many bills are sent monthly by placing the bill count for each month below:
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
152 152 152 152 152 152 152 152 152 152 152 152
Avg CC
Transaction $ 162.00 Max Invoice $ 500.00 Bill Frequency Monthly Avg. Bills Per
Month 152
PRODUCTS AND SERVICES
Products and Services [EBPP]
TRANSACTIONAL PRICING (Paid by Biller)
Payment Source Description Payment Method Fee Rate % Fee Amount $ Additional Fee $
All Payment Sources Credit/Debit/PayPal .5% $0.40
All Payment Sources ACH/EFT $0.75
TRANSACTIONAL PRICING EXCEPTIONS
SERVICE FEES (Paid by Payer)
Payment Source Description Payment Method Fee Amount Calculation
Type Min. Fee ($) per Transaction
All Payment Sources Credit/Debit/PayPal
All Payment Sources ACH/EFT
IVR Surcharge All Payment Methods
SERVICE FEE EXCEPTIONS
MAX PAYMENT CAP
Card and PayPal Max ($) 125,000 ACH Max ($) 125,000
BILLER BANK ACCOUNT (FOR DEPOSITS AND CHARGEBACKS)
Note: must include voided business check or bank letter for each unique account
Routing # Last 4 Acct # Last 4 Acct # for OBD
NOTES / SPECIAL HANDLING
Biller Order Form
Biller Order Form
BILLER ORDER FORM
INVOICE TYPE PARAMETER SHEET
Invoice Type Parameters must be completed for each invoice type
Invoice Type River Estates Pricing Model Non-Submitter
Christina Pavlovcpavlov@invoicecloud.comBiller Pays Network Fees Yes
CURRENT BILLING DETAILS
Please indicate how many bills are sent monthly by placing the bill count for each month below:
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
27 27 27 27 27 27 27 27 27 27 27 27
Avg CC
Transaction $ 227.00 Max Invoice $ 500.00 Bill Frequency Monthly Avg. Bills Per
Month 27
PRODUCTS AND SERVICES
Products and Services [EBPP]
TRANSACTIONAL PRICING (Paid by Biller)
Payment Source Description Payment Method Fee Rate % Fee Amount $ Additional Fee $
All Payment Sources Credit/Debit/PayPal .5% $0.40
All Payment Sources ACH/EFT $0.75
TRANSACTIONAL PRICING EXCEPTIONS
SERVICE FEES (Paid by Payer)
Payment Source Description Payment Method Fee Amount Calculation
Type Min. Fee ($) per Transaction
All Payment Sources Credit/Debit/PayPal
All Payment Sources ACH/EFT
IVR Surcharge All Payment Methods
SERVICE FEE EXCEPTIONS
MAX PAYMENT CAP
Card and PayPal Max ($) 125,000 ACH Max ($) 125,000
BILLER BANK ACCOUNT (FOR DEPOSITS AND CHARGEBACKS)
Note: must include voided business check or bank letter for each unique account
Routing # Last 4 Acct # Last 4 Acct # for OBD
NOTES / SPECIAL HANDLING
Biller Order Form
Biller Order Form
BILLER ORDER FORM
INVOICE TYPE PARAMETER SHEET
Invoice Type Parameters must be completed for each invoice type
Invoice Type Calpella Utility Pricing Model Non-Submitter
Christina Pavlovcpavlov@invoicecloud.comBiller Pays Network Fees Yes
CURRENT BILLING DETAILS
Please indicate how many bills are sent monthly by placing the bill count for each month below:
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
87 87 87 87 87 87 87 87 87 87 87 87
Avg CC
Transaction $ 165.00 Max Invoice $ 500.00 Bill Frequency Monthly Avg. Bills Per
Month 87
PRODUCTS AND SERVICES
Products and Services [EBPP]
TRANSACTIONAL PRICING (Paid by Biller)
Payment Source Description Payment Method Fee Rate % Fee Amount $ Additional Fee $
All Payment Sources Credit/Debit/PayPal .5% $0.40
All Payment Sources ACH/EFT $0.75
TRANSACTIONAL PRICING EXCEPTIONS
SERVICE FEES (Paid by Payer)
Payment Source Description Payment Method Fee Amount Calculation
Type Min. Fee ($) per Transaction
All Payment Sources Credit/Debit/PayPal
All Payment Sources ACH/EFT
IVR Surcharge All Payment Methods
SERVICE FEE EXCEPTIONS
MAX PAYMENT CAP
Card and PayPal Max ($) 125,000 ACH Max ($) 125,000
BILLER BANK ACCOUNT (FOR DEPOSITS AND CHARGEBACKS)
Note: must include voided business check or bank letter for each unique account
Routing # Last 4 Acct # Last 4 Acct # for OBD
NOTES / SPECIAL HANDLING
Biller Order Form