HomeMy Public PortalAboutHeartlandGOVERNMENT AND EDUCATION
MERCHANT PROCESSING AGREEMENT
Heartland ❑ Card Only ❑ ACH Only ❑ Dual
HEARTLAND
RM: Greg Ganim Phone: 972-8414776 Fax:
Affiliate/Partner ID : 9MUNIBIL Affiliate Name: MuniBilling Current MID:
COMPANY INFORMATION
Merchant DBA Name: Town of Gulf Stream DBA Phone#: 561-276-5116
Address: 100 Sea Rd. # Locations:
City: Gulf Stream State: FL Zip: 33483
CS Phone #: 561-276-5116 Fax #:
Primary Contact Name: Rebecca Tew Phone #:
Authorized to Purchase: ❑ Yes ❑ No
Secondary Contact Name:
Authorized to Purchase: ❑ Yes ❑ No
Email Address: rtewtaloulf-stream.om
Phone #:
561-276-5116
(Heartland InfoCentral Admin User Email Address)
Email Contact: First Name: Rebecca Last Name: Tew
Website Address: https://secure.munibilling.com. _
Legal Name: Town of Gulf Stream Federal Tax ID / EIN: 596002370
(Please Complete — Must correspond with IRS Filing Name) (Must correspond with
Legal Name)
Address: 100 Sea Rd. Phone #: 561-276-5116 _
City: Gulf Stream State: FL Zip: 33483
-. FEE SCHEDULE
Service fscount Dlseount
Requested Rate Per Item
Trans Trans
ea Dial Fee IP
Annual Volume: $57.000.00 1 Average Ticket: $300.00
Visa % $
$
$
High Ticket: $4000.00 Frequency: 4-6 Annually
MasterCard % $
$
$
® Service Fee (Pass Through/Single Transaction)
❑ COST PLUS
Discover/JCB % $
$ $
PayPal % $
$
$
PIN Debit'
$
$
`Plus Applicable Debit Network Fees
TSYS Authorizatio
$
$
American Express % $
$
$
Annual Volume: $ Average Ticket: $
Note: OptBlue Annual Processing Volume> $1 Million must go
Direct
❑OptBlue ❑ 1 opt out of receiving marketing material from
American Express
American Express
Merchant M
American Express
Franchise Name:
Franchise
CAP M
RECURRING FEES
Char aback Fee: $ Bolletta Fee:
$
Voice Auth Fee: $0.65 SRM Fee: $
-77
INTERCHANGE QUALIFICATION
❑ MOTO/Internet ❑ Retail ❑ Small Ticket
CARD ACCEPTANCE DEPOSIT .. SETTLEMENT
® All Cards Accepted ® Standard I ❑ Monthly ® Daily Net
SALES METHOD
On Premise Face to Face Sales %
Mall Order Sales %
CARD PROCESSING METHOD
Card Swipe %
Off Premise Face to Face Sales %
Real -Time Internet 100%
Keyed / Card Not Present 100%
Inbound Telephone Order Sales
%
Internet (keyed) %
Total =100%
Outbound Telephone Order Sales %
Recurring Billing %
Total= 100%
What percentage of your Bankcard volume Is future delivery
0%
ACH FEE SCHEDULE
Enable ACH Account Verification: [_]Yes ®No Please provide the expected ACH data below.
Fee Type Dollar Percents a Annual ACH Volume
$36,000
❑ Transaction Fee $ % Average ACH Ticket Amount
$300.00
❑ Service Fee $ % Average Number of ACH Transaction per Month
10
® Return Item Fee $5.00 High ACH Ticket Amount
$400.00
❑ Re -presentment Fee' $2.00 High Ticket Frequency
1-2 yr
'Re- resentment Limitation of 2 per NACHAguidelines) Max ACH Limit
$5,000.0
Note: For HI h Ticket Transactions, an additional I Sbo will be assessed on the amount above $10,000.
PROCESSINGACH •D
Note: Must equal 100% Single ACH Debit I Recurring ACH Debit Credit
CCD (Corporate Credit or Debit 50/, %
%
PPD (Prearranged Payment and Deposit) % %
%
TEL (Telephone) %
WEB 70% 1 30%
%
® ACH Debit PPD/CCD/WEB ❑ACH Conversion —Certification Required BOC/ARC/POP
❑ ACH TEL IVR I Other TEL Ent Types*)
Terminal Type:
Vendor: Heartland Third Party:
'Merchant can accept ACH payments via CashierNirtual
Check Reader/Imager:
Virtual Terminal:
terminal; however, call must be recorded and be available
as proof of authorization.
Number of Terminals:
ACH DESCRIPTOR
Phone number as it will appear on customer statements:
Company name as it will appear on customer bank statements Max 16 Characters):
AUTHORIZATION METHOD (Not applicable to ACH Conversion)
Which authorization procedure does Merchant utilize to confirm customers consent to an ACH Debit:
❑ Signed written authorization from customer (Does not apply to Web)
❑ Heartland provides Authorization Form Template
❑ Merchant created Authorization Form
❑ Web Authorization (Applies to Web only)
❑ Customer provides electronic signature ❑ Customer logs in a username and password
❑ Recorded Verbal Authorization (Tel Only)
❑ Heartland provided script ❑ Merchant created script
If utilizing Recorded Verbal Authorization; check one of the following:
❑ Hosted secure IVR (Automated or Live Agent) recording services offered by Heartland
❑ Merchant has existing recording service to capture verbal customer authorizations
How are recordings stored:
❑ Via website URL:
❑ Via hone: #:
REQUIRED: When Merchant utilizes their own Authorization Script this must be submitted with ACH Application.
MERCHANT DETAIL
Type of Business: ❑ Public ❑ Private Date Business Started: Business is Conducted: 95% Consumer
Type of Ownership: Corporation ❑ Government Municipalities Are web based sales processed by
HPS: Yes
Has your business experienced a cardholder account data
If yes, what was the date of the compromise:_
compromise: ❑Yes [:]No
Note: A copy of the completed Forensic Investigation is required
Is your business PCI Compliant: ❑ Yes ❑ No
I with Application
What Products and / or services do youprovide: These are Water, sewer, and trash Payments
Is there a eak week / date In the month for processingrecurringtransactions: i.e., 11 •t and 151h):
N/A
Define our Refund Policy: We do not provide refunds
STATEMENT OPTIONS DISPUTE LETTERS
Statement Type: ® Standard Mail O tions: ❑ Legal ❑ DBA
Mail Statements To: ® Suppress Slmts ❑ Legal Electronic Options* ❑ Email ❑ Fax(*Select mall option as backup)
❑ All Electronic Communications (Including ACH Returns):
❑ Same Email as InfoCentral ❑ Preferred Email Address:rtew ulf-stream.o
AUTHORIZED • •
1 Authorized Signer Name: William Thrasher Title: Town Manager
SSN: DOB: 08/12/1947 Driver's License #:
Home Address City: ST: zip:
2 Authorized Signer Name: Title:
SSN: DOB: Driver's License #:
Home Address: City: ST: zip:
•EBIT / CREDIT AUTHORIZATION
By signing below, Merchant certifies that any verification of business provided is for a business account in good
standing and that the business name on the account is the same as the business name on the enclosed Heartland
Payment Systems Merchant Application. Merchant hereby authorizes Acquirer to debit and credit Merchant's
checking/savings/GL Account. This authority shall remain in full force until (a) Acquirer has received written notification
from Merchant of its termination; and (b) all obligations of Merchant to Acquirer under this Agreement have been paid in
full.
Depository Bank Name: Fla ler Bank Phone #:
City: West Palm Beach I ST: FL zi
CARD TRANSIT ROUTERACCOUNT
ACCOUNT TYPE check one ® Checking ❑ Savings 1 067014961 7 0018205
FUNDS TRANSFER METHOD ® Deposits ❑ Fees []Both Name as it appears on Account: Town of Gulf
TRANSIT ROUTER / ABA NUMBER (9 digits) ACCOUNT NUMBER 14 digits)
ACCOUNT TYPE check one ❑ Checkin ❑ Savings 1 053000219 2642264200
FUNDS TRANSFER METHOD ❑ Deposits ® Fees ❑ Both I Name as it appears on Account: Crestline Soft
ROUTER/ACH TRANSIT ACCOUNT
ACCOUNT TYPE check one Checking Savings 067014961 7 0018205
FUNDS TRANSFER METHOD ® Deposits ❑ Fees ❑ Both Name as it appears on Account: Town of Gulf
TRANSIT ROUTER / ABA NUMBER (9 digits) ACCOUNT NUMBER 14 digits)
ACCOUNT TYPE check one ❑ Checking ❑ savings 053000219 1 2642264200
FUNDS TRANSFER METHOD C3 Deposits ® Fees ❑ Both Name as it appears on Account Crestline Soft
CERTIFICATIONAGREEMENT ACCEPTANCE, •NSUMER REPORT AUTHORIZATION
Has your business filed Bankruptcy, had Judgments or Liens within the last 3 ears: ❑ Yes ❑ No
Merchant authorizes Acquirer, reporting agency employed by Acquirer, or any agents thereof, to Investigate the
references, statements or data provided by Merchant or the undersigned for purposes of all matters generally
connected to this business relationship. I further certify that I have received, read, understand and agree to the
Merchant Processing Agreement Terms and Conditions which together with this application shall constitute the
agreement(s) between the parties. I further certify that this business or any Owner/Officer/Authorized Signer has
never be to mat d by any Card Brand.
�• ! William Thrasher -Town Manager
U r Signature Print Name & Title Date
X
(2) Authorized Signer Signature Print Name & Title Date
THE TERM OF THIS AGREEMENT IS 12 MONTHS
12/14/16 11
Heartland
Terms & Conditions Acknowledgement
"Merchant" acknowledges that Heartland Payment Systems, Inc. ("Heartland") has provided it with a copy of
the ACH Processing Agreement — ACH Acceptance Policies I Procedures I Terms & Conditions (the "Terms
and Conditions') and the Application, which together make up the entire agreement between the parties.
Merchant has read, understands, and agrees to be bound by the Terms and Conditions, as may be amended
from time to time.
Merchant acknowledges that the Terms and Conditions are a fundamental part of the parties' agreement
without which Heartland would not be able to enter into an agreement with the Merchant.
In addition, Merchant can request another copy of the Terms and Conditions at any time by sending a written
request for a copy to Heartland at the following address:
Heartland Payment Systems; Attn Customer Care; One Heartland Way; Jeffersonville IN 47130
Title of the Agreement Received: Government and Public Education ACH Processing Agreement Terms
and Conditions
Creation or Revision Date of the Agreement Received:
Merchant Signature
Print Name and Title
X Greg Ganim - Bolletta/eComm SPA
Relationship Manager Signature Print Name and Title
Date
Date
Revised: 02/06/15
Member Sponsor Bank Disclosure Service Provider Contact Information:
Heartland Heartland Payment Systems
One Heartland Way, Jeffersonville, IN 47130
H eartla nd Paym entsystems.com
(888)963-3600
Merchant Name: Town of Gulf Stream
Address: 100 Sea Rd.
city: Gulf Stream ST: FL
Contact Name: Rebecca Tew Phone #: 561-276-5116
IMPORTANT MERCHANT RESPONSIBILITIES
1. Merchant must ensure compliance with cardholder data security and storage requirements.
2. Merchant must maintain fraud and chargeback below thresholds.
3. Merchant must review and understand the terms of the Merchant Processing Agreement.
4. Merchant must comply with the Card Brands Operating Regulations.
5. Merchant must retain a signed copy of this Disclosure Page.
zip: 33483
Note: The responsibilities listed above do not supersede terms of the Merchant Processing Agreement and are provided
to ensure the merchant understands some important obligations of each party and that the Member Sponsor Bank
(Acquirer) is the ultimate authority should the merchant have any problems.
IMPORTANT MEMBER SPONSOR BANK (ACQUIRER) RESPONSIBILITIES
1. The Member Sponsor Bank is the only enti approved to extend acceptance of Card Brand products directly to a
Merchant.
2. The Member Sponsor Bank must be a principal (signer) to the Merchant Processing Agreement.
3. The Member Sponsor Bank is responsible for educating Merchants on pertinent Card Brand Operating Regulations
with which Merchants must comply.
4. The Member Sponsor Bank is responsible for and must settle funds with the Merchant.
5. The Member Sponsor Bank is responsible for all funds held in reserve that are derived from settlement.
MERCHANT RESOURCES
1. You may download Visa Regulations from Visa's website at: hfto://usa.visa.com/merchants/merchant-
su 000rt/i nternational-operating-regulations. iso
2. You may download MasterCard Rules from MasterCard's website at:
hftp://mastercard.com/us/merchanYsupporUrules.html.
Member Sponsor Bank (Acquirer) Information:*
Barclay Bank The Bancorp Bank
Wells Fargo Bank, N.A
125 South West Street 409 Silverside Road, Suite 105
1200 Montego
Wilmington, DE. 19801 Wilmington, DE. 19809
Walnut Creek, CA 94598
Phone: (302) 662-8990 Phone: (302) 385-5000
Phone: (925) 746-4167
Debit Bank Sponsor
Bay Bank, FSB
7151 Columbia Gateway Drive
Suite A
Columbia, MD 21046
I, the undersigned hereby acknowledge and agree that Heartland Payment Systems will select one of the Member Sponsor
Bank's listed above based on the following criteria; business type, POS equipment compatibility, depository institution
and/or existing HPS relationship. Heartland Payment Systems will provide Merchant a written notification of the Member
Sponsor Bank that Is selected. By presenting any Card Brand Transaction to Heartland Payment Systems under the
Merchant Processing Agreement from and after notice of the Member Sponsor Bank, you agree that the Member Sponsor
Bank so selected shall be Immediately a principal party (signer) to the Merchant Processing Agreement, regarding
acceptance of Card Brand transactions. W;'[[," H.
William Thrasher - Town Mgr. WHIM. H.Th.s r(Jen 6,201n
Merchant's Name Printed Merchant's Signature Date
Date Received
Bank Use Only
Date Installed
HPS Rep Name
Revised: 09/02/15
Heartland
Terms & Conditions Acknowledgement
"Merchant" acknowledges that Heartland Payment Systems, Inc. ("Heartland") has provided it with a copy of the Government
and Education Processing Terms & Conditions (the 'Terms and Conditions") and the K-12 Merchant Application, which
together with the Addendum to the Government and Education Processing Agreement ("Addendum"), make up
the entire agreement between the parties. Merchant has read, understands, and agrees to be bound by the Terms and
Conditions, as modified by the Addendum, and as may be amended from time to time as provided in the Addendum. Merchant
acknowledges that the Terms and Conditions, as modified by the Addendum, are a fundamental part of the parties'
agreement without which Headland would not be able to enter into an agreement with the Merchant.
William Thrasher - Town Mgr.
will em H. Printed Name Date
Merchant Signature Printed Name Date
Site Inspection
I hereby verify that (check one)
® This District and their locations have the proper facilities, equipment, inventory, and proper accreditation certificates required
to conduct the business.
® I was not reasonably able to complete a Site Inspection of the Merchant at this Address, and the Information staled below is
correct to the best of my knowledge and belief. Please explain why a site inspection could not be performed: Located in Florida
Greg Ganim
Inspected By: Signature Printed Name Dale
It is required that the following questions be completed.
Is business signage present: ® Yes ❑ No Describe signage:
NumberofTerminals: Locations: Are card acceptance logos displayed foreasyview: ❑Yes ❑No
If this is an additional location to an existing HPS n sada under the same District, was a site inspection performed on
any of the locations? ❑Yes ®No
Revised: 05/15/15
V'' H e a r t l a n d ' "
1 0 0 B I L L I N G S O L U T I O N S
H e a r t l a n d R e q u i r e d M e r c h a n t I n f o r m a t i o n ( G o v e r n m e n t )
1 . D B A N a m e : T o w n o f G u l f S t r e a m
2 . L e g a l B u s i n e s s N a m e : T o w n o f G u l f S t r e a m
3 . B u s i n e s s E n t i t y : G o v e r n m e n t
4 . D B A B u s i n e s s A d d r e s s : ( P l e a s e s e n d p i c t u r e o f s t o r e f r o n t i n c l u d i n g s i g n )
P l e a s e v i s i t t o w n w e b s i t e a t : w w w . g u l f - s t r e a m . o r g
5 . B u s i n e s s T e l e p h o n e a n d F a x N u m b e r :
P h : 5 6 1 - 2 7 6 - 5 1 1 6 F a x : 5 6 1 - 7 3 7 - 0 1 8 8
6 . N a m e a n d a d d r e s s o f p r i m a r y A d m i n f o r o u r r e p o r t i n g s y s t e m .
W i l l i a m T h r a s h e r
1 0 0 S e a R d .
G u l f S t r e a m , F L 3 3 4 8 3
7 . L e g a l B u s i n e s s A d d r e s s ( i f d i f f e r e n t t h a n D B A ) :
8 . F e d e r a l T a x I D N u m b e r :
5 9 - 6 0 0 2 3 7 0
9 . O w n e r o r S i g n e r N a m e :
T i t l e T o w n M a n a g e r
D O B 8 / 1 2 / 4 7
1 0 . B a n k A c c o u n t I n f o B a n k n a m e , r o u t i n g # , a c c o u n t # , c i t y s t a t e
F l a g l e r B a n k , W e s t P a l m B e a c h , F L
R o u t i n g # : 0 6 7 0 1 4 9 6 1
A c c o u n t # : 0 0 1 8 2 0 5
1 1 . V o i d e d C h e c k ( P l e a s e p r o v i d e ) :
V'' t H e a r t l a n d
��f ��i t l l B I L L I N G S O L U T I O N S
1 2 . D o y o u c u r r e n t l y a c c e p t c r e d i t c a r d s ? Y e s
1 3 . D a t e y o u s t a r t e d a c c e p t i n g c a r d s : 2 0 1 1
1 4 . W h a t i s y o u r a v e r a g e t i c k e t ?
A p p r o x i m a t e l y $ 3 0 0 . 0 0
1 5 . W h a t i s y o u r h i g h t i c k e t ?
$ 4 , 0 0 0 . 0 0
1 6 . H o w m a n y t i m e s a m o n t h d o y o u h i t y o u r h i g h t i c k e t a m o u n t ?
A b o u t o n c e o r t w i c e e v e r y t w o m o n t h s
1 7 . P l e a s e p r o v i d e 3 m o s t r e c e n t c r e d i t c a r d s t a t e m e n t s , o r b a n k s t a t e m e n t s i f y o u h a v e
n o t p r e v i o u s l y t a k e n c r e d i t c a r d s .
1 8 . E v e r F i l e d B a n k r u p t c y ? N o
1 9 . W e b s i t e A d d r e s s : h t t p s : / / s e c u r e . m u n i b i I l i n g . c o m
2 0 . I n t e r n e t P o l i c i e s o n w e b s i t e i e , S h i p p i n g , R e t u r n , P r i v a c y , S e c u r i t y :
P r i v a c y p o l i c y l i s t e d o n w e b s i t e
2 1 . D o y o u h a v e y o u r c u s t o m e r s s i g n a c o n t r a c t ? N o
2 2 . W h o w i l l b e t h e p r i m a r y c o n t a c t a n d A d m i n f o r o u r r e p o r t i n g s y s t e m ? P l e a s e p r o v i d e
n a m e a n d e m a i l a d d r e s s .
R e b e c c a T e w , r t e w @ g u l f - s t r e a m . o r g
2 3 . D e s c r i b e R e t u r n C h e c k P o l i c y
P e n a l t y f e e o f $ 2 0 . 0 0
2 4 . D e s c r i b e R e f u n d P o l i c y ( I t ' s o k t o n o t p r o v i d e r e f u n d s )
I f w e d o i s s u e a r e f u n d i t i s d u e t o g r o s s o v e r p a y m e n t o n t h e a c c o u n t a n d o u r f i n a n c e
d e p a r t m e n t i s s u e s a r e f u n d c h e c k .
2 5 . W h a t % o f y o u r b u s i n e s s i s c o n s u m e r v s . B 2 1 3 ?
1 0 0 % c o n s u m e r
j '-BILLING
ONLINE PAYMENT PRICING AGREEMENT
Merchant DBA Name
MERCHANT FEES
Monthly fee waived.
Town of Gulf Stream, FL
Merchant Account Fee
MonthPer 00
TRANSACTION FEES
The fees below will be presented at the time of transaction, to be paid by the customer.
Credit Card Payment Amount - $5,000 maximum Fee
00
01 - $100.00 60
00 00 .0
$200.00 $ 5.20
$200.00 000
eCheck Payment Amount - $10,000 Maximum Fee
0 - $10,000.00 $ 0.50
Chargebacks are subject to a fee of up to $30 if imposed by the card issuing bank. No other fees will be
charged to the customer or Merchant for credit card or eCheck transactions.
Merchant Representative
Name
Signa
Date
MuniBilling Representative
Name Charles Ki��ttlee/r �i ,,nn
Signature ( A -4t Ga'1'
Date 1/3/2017