MERCHANT AGREEMENT ADDENDUM
REQUEST FOR ADDITIONAL ENTITLEMENTS

I, the undersigned principal nor corporate officer, hereby request the entitlements checked below be added to our  merchant account:

ڤ AMERICAN EXPRESS    Discount rate: _3.50___%
Transaction fee: $0.25
Monthly fee (keyed merchants only) (1) $5.95

ڤ DISCOVER   Discount rate: __________%
Transaction fee: $0.25
Membership fee:(2) $25.00

ڤ DINERS CLUB/CARTE BLANCHE   Discount rate: _______%
Complete Merchant Addendum for Diners Club Card/ Transaction fee: $0.28
Carte Blanche Authorizations and Settlement (form Monthly minimum: $7.50
DEB-1004).

ڤ JCB   Discount rate: _______%
Transaction fee: $0.25
Monthly minimum: $7.50

(1)American Express keyed merchants will be accessed a flat fee of $5.95 per month or a discount rate. This monthly $5.95 flat fee will be accessed until the merchant has processed five thousand dollars or more in charge volume annually. Once this processing volume threshold is reached, the account will only be charged the American Express discount rate of 3.5% from that point forward, and will not be subject to the monthly $5.95 flat fee.

(2)The Discover membership is collected via a separate ACH by Discover within forty-five days of Discover approval.


Authorization for:

Merchant DBA: _________________________________

Merchant number: _________________________________

By:
_______________________________________________ ______________________
Principal or Corporate Officer Date