HomeMy WebLinkAbout5.683 Original Contract (2)
Nova
3/24/2004 12:26
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MERCHANT REQUEST TO ADD CARD TYPE
Date: March 24, 2004 Boarding Department
Please complete and sign below, then 7301 Chapman Hwy.
Fax to; 865-403-5693 Knoxville TN 37920-6611
Attn: Card Type A~d Requests Attn: Card T e Adds
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~ I hereby request that the following card types be added to the merchant processing
account for the business indicated below. I understand that by requesting the ability to
accept these card types through my pas device, I am responsible for any errors that
may occur as a result of incorrect card type merchant numbers entered by me below. I
am also responsible for all authorization fees (if applicable) to be billed on the
monthly statement. I further understand that the card companies will pay me for these
transactions and collect any fees directly from my account. I acknowledge that
NOVA is not liable for any billing or payment errors made by the card companies in
the processing of these transactions.
I,x YtJ ON'!f6 d{ 0 fJ1 ,ko~ttertify that I am the owner (if privately owned) or the
authorized officer (if incorporated), and have the authorization to make adjustments to
this account.
Xsignature -Date 3:;2 1)1; Title :}i/tdVw {fL.-
Name of Business: PARKS AND RECREATI
Merchant ID#: 9508142313 Date of Request: 03/24/04
Contact Name: Kathy
Address: 321 E5THSTREET
City: PORT ANGELES
Telephone#: 360-417-4550
Email address:
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State: W A ZIP: 98362
Fax#: 360-417-4711
Sales Rep#:
Please complete card type merchant numbers (SE #'s) to be added:
Auth Fee
Auth Fee
Discover: 60110
Amex:
Diners/Carte Blanche:
JCB:
~40
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