Loyalty Program Application

255 Rt. 17 South Hackensack , NJ 07601 Tel. 800-260-3388 Fax. 201-562-1486

New
Legal Name

Loyalty Only

Existing Merchant ID
DBA Name

Date ____/____/____

10 6 11

Business Information

Forrest and Smith Investments Top It Off - fantastically frozen yogurt

City State Zip Code

Address

401 Broad St Ste 105

Business Phone Fax

Chattanooga
E-mail

TN

37402
#of Locations

423-475-5192
Owner Name

TopItOffFroyo@gmail.com
SS # Home Phone #

1
931-242-0964

Owner Information

Zach Smith 4125 Safehaven Ct

Nurit 2085

Home Address

City

State

Zip Code

Chattanooga
Nurit 8320 Omni3730 Omni 3740/ Omni3750 Visanet Other :

TN
Nurit 3000 series FG1000 Vx 570 Ethernet

37406

Equipment Information

Terminal Type
Bankcard Processor

Omni 3740

Other : Nurit 8320 LAN

IP Transaction Server Supported Terminal

Global Paymentech

Single Location
Corporation Merchant ID Corporation DBA Name
Schedule of Charges

Multi Locations

( If choose Multi Locations, please fill out Corporation Merchant ID & DBA Name)

IP Transaction Server*

Yes
$ $ $ $ $ $

No
IP Transaction Server Bundle Plan*
.00 .00 .00 .00

Monthly Rate Fee

Plan 1 Plan 2 Plan 3 Plan 4

.00

Monthly Fee Corporation Monthly Web Access Fee** Monthly Web Access Fee Transaction Fee Transaction Minimum Fee Annual Fee
* UMS credit card processing merchants only **Multi Locations Only

Monthly Web Access Fee Annual Fee

.Plan 1 500 Transactions Per Month Plan 3 5000 Transactions Per Month Additional Transaction

$ $

05.00 20 .00

10 .00
.00

Plan 2 2000 Transactions Per Month Plan 4 Unlimited

$0.10 Per Transaction

The term of this Agreement shall commence for ONE year from the date UMSIs acceptance. There is a cancellation fee of $200.00. This fee applies solely to cancellation of the Loyalty Agreement. Other cancellation fees may apply as relates to bankcard processing or other additional services. Refer to terms and Conditions for further details.

Credit Card Payment

Visa

Master Card

American Express

Discover

Card #

04 14 Expiration Date: __ __/ __ __ CVV# 436

I agree to pay according to cardholders agreement

Signature

________________________________________________

VOID CHECK

Terms and Conditions Merchant agrees to pay the fees set forth above. Merchant understands that participation in the Electronic Gift Card and Loyalty Card Program is governed by the Merchant Processing Agreement and the terms and conditions set forth on the reverse side of this form. ________________________________________________________________ Merchant Name ______________________________________________ #_______________ ISO Name Number UMSI Officer

Please Staple

Top It Off

________________________________________ Signature _________________________________________ Signature

____________________________________________ ____________________________ ______________

Approved By Name Date
Rev. 01/10

United Merchant Services, Inc.

Electronic Gift Card / Loyalty Program Terms and Conditions
Merchant agrees to pay to UMSI the fees set forth on this Enrollment Form in the manner provided on this Enrollment Form. Merchant acknowledges and agrees that its participation in the UMSA Electronic Gift card / Loyalty program (EGCL Program) and acceptance of electronic gift cards is governed by the Merchant Agreement between Merchant and UMSI. In the event of a conflict between the Merchant Agreement and these terms and conditions, these terms and conditions will control. Merchant acknowledges that there are certain state and federal laws, rules and regulations applicable to the issuance, use and acceptance of gift cards and/or the operation of customer loyalty programs, specifically including, but not limited to, laws applicable to expiration dates escheat. Merchant agrees that it has sole responsibility to comply with all such laws, rules, or regulations at all times. Merchant further agrees to provide assistance to UMSI with respect to compliance with any such laws, rules and regulations as may be applicable to UMSI with respect to the EGCL Program. Merchant acknowledges and agrees that title to all customer data created through the EGCL Program will vest solely in UMSI. Upon termination of the relationship between UMSI and Merchant and/or the EGCL Program, Merchant shall have no rights whatsoever to any data created through the EGCL Program. UMSI SHALL NOT BE LIABLE FOR INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES INCLUDING LOSSES RESULTING FROM DESTRUCTION OR DAMAGE OF RECORDS, LOST DATA OR LOST PROFITS. THE LIMIT OF MONETARY DAMAGES AGAINST UMSI UNDER ANY CIRCUMSTANCES SHALL BE THE AMOUNT PAID BY MERCHANT TO UMSI PURSUANT TO THE EGCL PROGRAM IN THE THIRTY (30) DAYS PRECEDING THE DATE ANY CLAIM AGAINST UMSI AROSE. UMSI DOES NOT MAKE ANY REPRESENTATIONS OR WARRANTIES, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION (A) ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE EGCL PROGRAM OR ANY ELECTRONIC GIFT CARDS FURNISHED TO MERCHANT HEREUNDER OR (B) ANY REPRESENTATION OR WARRANTY WITH RESPECT TO THE COMPLIANCE OF THE EGCL PROGRAM OR THE USE, ISSUANCE OR ACCEPTANCE OF ANY ELECTRONIC GIFT CARDS WITH AND FEDERAL, STATE OR LOCAL LAWS, RULES OR REGULATIONS. UMSI shall not have any liability whatsoever for any lost or stolen electronic gift cards. All disputes between Merchant and its consumers relating to any electronic gift card or loyalty program transactions shall be settled between the Merchant and its consumer. Merchant shall indemnify, defend and hold UMSI harmless from and against any and all claims, costs and/or liabilities, including any reasonable attorneys fees and costs incurred by UMSI and arising out of the EGCL Program or the issuance, use or acceptance of electronic gift cards. In the event Merchant has selected the Automated Clearing House payment option (ACH Option) in the Merchant Agreement, Merchant hereby authorizes UMSI or its bank to debit the account identified by Merchant in connection with such ACH Option periodically for any fees or other payments due from Merchant to UMSI hereunder. UMSI will commence billing for the Monthly Web Access Fee and Statement Fee from the date UMSI provides written acceptance and approval of this Agreement. The EGCL Program and these Terms and Conditions shall not be subject to termination by Merchant prior to the one year anniversary of the date on which UMSI provided written acceptance and approval of Merchants EGCL account except upon payment of an earlytermination fee of $200.00. In the event Merchant elected to receive 100 free gift cards at the time the application for the EGCL Program was submitted, any termination prior to the one year anniversary of the date on which such free gift cards were issued shall also be subject to an additional $100.00 early termination fee payable by Merchant to UMSI. UMSI shall have the right in its sole discretion to withhold or set-off any termination fees here under from any funds of Merchant then held by UMSI or charge to any account (credit card or otherwise) that Merchant has authorized UMSI to charge fees against any such termination fees. UMSI reserves the right to terminate Merchants EGCL Program at any time for any reason.

These Terms and Conditions and the EGCL Program shall be governed by the laws of the State of New Jersey, without regard to any conflicts of laws principles. Any dispute arising out of or related to these Terms and Conditions and the EGCL Program shall be subject to the exclusive jurisdiction of the state or federal courts located in the State of New Jersey and Merchant hereby consents to the exclusive personal jurisdiction of such courts over Merchant.

Merchant Initial_____________

CUSTOMIZED CARD ORDER FORM

Card Design

Customized

Selected design from a sample book : _______________________

*Please indicate the sample number

Use DBA company name indicated above on my gift cards Copy of logo is attached
Printing Options

Use my company logo on gift cards instead of DBA name Zip Disk CD Rom E-Mail

Paper Logo

3.5 Floppy Disk One Spot Color Printing

Full Color
Card Order

Two Spot Color Printing

Quantity Price Per Card Shipping & Handling Logo Set Up Fee

1000
0 50 $ ____. ___ ____
$ $

# of Gift Cards :_________

# of Point Cards :__________

100 FREE Gift Cards

* Offer valid for merchants using UMSIs bankcard processing services only. * Merchant agrees to accept all applicable gift card processing fees as stated at right. * If a merchant receives cards and cancels on or before one year from the date cards are issued, UMSI will charge an additional $100.00 cancellation fee. * Spot color design only

50.00

Total Fee*
Design Proof By

* Customized gift/loyalty card orders must be paid in full before work orders are submitted for processing. * Money orders and credit card payments only. No personal checks accepted. * Logo Set Up Fee is non-refundable. This Agreement is subject to a $200 cancellation fee if termination within one year of the date this application is approved by UMSI. See Terms and Conditions on the below of this application.

TopItOffFroyo gmail.com E-Mail : ________________@_____________

Spot Color Printing Choices
Card Options

Mail

Sample Cards actually printed ( The cost is $10.00 per 3 cards)

Color for Lettering and Graphics

White Card Silver Pearl Card

Black Card Gold Pearl Card

White Gold Silver Back

Black Burgundy Process Blue

Teal Green Red

Warm Red Royal Blue

Front

*Please place here what youd like the card to look like.
Terms & Conditions

Card Range

to #

The EGCL(Electronic Gift card / Loyalty) Program and these Terms and Conditions shall not be subject to termination by Merchant prior to the one year anniversary of the date on which UMSI provided written acceptance and approval of Merchants EGCL account except upon payment of an early-termination fee of $200.00, which UMSI shall have the right to withhold from any funds of Merchant then held by UMSI or charge to any account (credit card or otherwise) that Merchant has authorized UMSI to charge fees against. In the event Merchant elected to receive 100 free gift cards at the time the application for the EGCL Program was submitted, any termination prior to the one year anniversary of the date on which such free gift cards were issued shall also be subject to an additional $100.00 early termination fee payable by Merchant and subject to being withheld by UMSI from any funds of Merchant on deposit with UMSI or charged to any account (credit card or otherwise) that Merchant has authorized UMSI to charge fees against. UMSI reserves the right to terminate Merchants EGCL at any time. The Logo Set Up Fee is non-refundable. The approved design of the colored cards that sent by e-mail as previewed on the monitor screen may be slightly altered from the actual desired results when reproduced on the print out. UMSI will not issue any refunds or exchanges for these discrepancies.

I agree to accept this Terms & Conditions

Signature ______________________________________________________________