Electronic Check Verification

<%@ Language=VBScript %> Electronic Check Verification

CHEXpedite Electronic Check Verification
Merchant Application/Agreement

DBA (customer's checks will be made payable to):
Company Name(Corporate Offices):

Federal ID#:

State ID#:

Sales Tax#:

HQ-Address:

Email:

City:

State:

Zip:

Phone:

Fax:

Owner:

SS#:

Address:

Email:

City:

State:

Zip:

Phone:

Banking Information: (This is the Bank to which your fees will be electronically debited.) Please include a copy of a voided check from this account.

Name of Primary Bank:		Phone:
Name(s) on Account:
Bank RTN:		Account Number:

(Note: Please include a copy of a voided Check from the account above.)

Does the Company wish to impose limits on the individual amount, total amount or number of checks converted by the company?
If yes, specify limits:
Number of checks per day	Dollar limit per check	Total dollar limit per day

Does the Company wish to impose limits on the amount or number of checks from any one customer that can be converted?
If yes, specify limits:
Number of checks per day	Dollar limit per check	Total dollar limit per day

The undersigned certifies the accuracy of all the foregoing information and authorizes Bank, agents or other investigative agency employed by National Bank Drafting Systems, Inc. to investigate the reference given to National Bank Drafting Systems, Inc. or statements or other data contained herein obtained from merchant or from other persons pertaining to merchant's credit, financial responsibility or accuracy of any of the foregoing information. I/We further agree to notify National Bank Drafting Systems, Inc. of any and all changes, which may occur from time to time in the information and statements contained herein.

SCHEDULE OF FEES

Setup Fee: $99.00 per location plus $12 per terminal for implementation and programming of Point Of Sale terminal(s) and peripheral equipment. If this application is approved, the undersigned hereby authorizes an electronic debit in the amount of the Setup Fee from the above named bank account.

Transaction Fee: $.14 cents per item verified or a minimum monthly charge of $10.

ADDITIONAL TERMS AND CONDITIONS

This agreement is between the above named company and National Bank Drafting Systems, Inc. (NBDS, Inc.) located at 6707 Brentwood Stair Rd., Suite 640, Fort Worth, Texas 76112. This agreement constitutes the only agreement between the parties for said services and all prior negotiations, agreements, and understandings, whether oral or written, are therefore superseded. Any other processing agreements between NBDS, Inc. and the above named merchant shall not affect the terms of this agreement. No modification or amendment of this agreement shall be effective unless in writing and signed by all parties. The person signing this agreement certifies that he/she is authorized to enter into this agreement on behalf of the client.

Agreed and accepted by:
Company Representative	National Bank Drafting Systems, Inc. Representative

By:	By: ________________________________________________________
Date: <%= formatdatetime(now(), vbshortdate)%>	Date: ____________

Licensee Number: _____________	Rep Id#: _____________	Rep. Name: _____________

Electronic Check Conversions ^tm and Check Collect ^tm are licensed trademarks of National Bank Drafting Systems, Inc., Fort Worth, Texas Terms and Conditions set forth on the reverse side are hereby made a part of the agreement.

Terms and Conditions

This agreement is entered into by and between National Bank Drafting Systems, Inc. (hereinafter referred to as NBDS, Inc.) and the business signing this agreement (hereinafter referred to as �Client�). NBDS, Inc. contracts to provide Client with �check verification� services.

NBDS, Inc. will provide the client access to a current database identifying persons and entities reported as having a checks(s) for which payment is owed to a merchant whose return checks experience has been reported to the database management company by member contributors, which include but is not limited to, National Bank Drafting Systems, Inc., Peak Check Services, Check Collect�, Electronic Check Conversion� and Electronic Financial Group, Inc. Client agrees to verify checks only at the time of acceptance.

Client hereby agrees to indemnify and hold harmless NBDS, Inc or any of its employees and any agents of NBDS, Inc. and the agent�s employees from any liabilities arising out of the misuse of any information obtained through the check verification process.

Client agrees that NBDS, Inc. information will not be used for employment purposes, for the extension of credit, for insurance purposes or for any other purpose which is prohibited by the Fair Credit Reporting Act (Public Law 91-508), or any other law presently governing such information supplied by NBDS, Inc. or any law which subsequently shall govern said information. Client furthermore agrees that the information furnished by NBDS, Inc. will be used only for the exclusive use of the Client and will not be made available to third parties.

NBDS, Inc. will provide Client with the programming information necessary to verify checks electronically through NBDS, Inc.�s verification system. Client agrees to have the provider of their point of sale terminal enter and maintain this programming information. Should NBDS, Inc. be asked to enter and/or maintain programming information into a point of sale terminal not provided by NBDS, Inc., Client agrees to pay NBDS, Inc.�s current reprogramming charge.

AUTHORITY

Each party of the agreement hereby represents and warrants to the other that it has full right, power, and authority to enter into and to perform this agreement in accordance with all of the terms, provisions, covenants and conditions hereof, and that the execution and delivery of this agreement has been duly authorized by proper corporate action.

SPECIAL EVENTS

In the event any of the parties to this agreement shall cease conducting business in the ordinary course; becomes insolvent; makes a general assignment of a receiver for its business or assets; or shall avail itself of, or become subject to any proceeding under Federal Bankruptcy Laws of any statue of any state relating to insolvency or the protection of the rights of creditors, then (at the option of the parties hereto), this agreement shall terminate and be of no further force and effect, and any property or rights of such other parties, tangible or intangible, shall forthwith be returned to them.

FORCE MAJEURE

Each party hereto will be excused from performance hereunder when and to the extent that it is prevented from performance by, but not limited to, the following: computer, utility or communications breakdowns; inability to operate or obtain service for its equipment; fire; act of God; or any act of a third party beyond its control provided that it takes all steps reasonably practical and necessary to effect prompt resumption of its respective responsibilities set forth hereunder in full or in part.

BENEFIT

This agreement shall be binding upon and shall inure to the benefit of the parties hereto and their representatives and successors and assigns.

ATTORNEY'S FEES

Should NBDS, Inc., be required to seek services of an attorney to enforce its rights hereunder, the Location will pay all attorney's fees and other collection fees and legal costs incurred by that party in connection herewith.

LAW

This agreement shall be governed by and construed in accordance with the laws of the State of Texas.

SEVERABILITY

Should any of the provisions of the agreement be invalid, such invalidity shall not affect the validity of the remaining provisions.

TERM

This agreement together with attached schedules is entered into as of the date accepted by NBDS, Inc. and shall remain in full force and effect until terminated by either party by giving the other party a 30 day written notice.

CONFIDENTIALITY

Location, its employees and agents shall treat as confidential all information that comes to its attention in the performance of its duties under this agreement and shall utilize such information only for the duties and obligations contained herein.

INDEMNIFICATION

Each party shall indemnify, defend, and hold harmless the other party from and against any and all losses, damages, costs, and expenses including reasonable attorney's fees and costs resulting from, or rising out of, or in connection with indemnifying the party's failure to comply with the terms of this agreement.

ADVERTISING

Merchant shall use its best efforts to advertise the services provided by NBDS, Inc., including NBDS, Inc.'s trade name, logo in a form provided by NBDS, Inc.

REMEDIES

NBDS, Inc. reserves the right to suspend its performance or terminate this agreement including its obligation to electronically transmit previously received tax returns during any period in which the location's account is delinquent or if the location has violated this agreement or IRS regulations. NBDS, Inc. shall have the right to offset amounts due the location with any amounts due NBDS, Inc. NBDS, Inc.'s continuation of performance, thereafter, shall not constitute a waiver of any of NBDS, INC.. Inc.'s rights under this agreement and the rights contained in this paragraph shall be in addition to any other remedies at law or equity.

NOTICES

As except as otherwise provided in this agreement, any location required or given under this agreement shall be in writing and shall be deemed valid within 48 hours after deposit in first class United States mail, postage prepaid, or if other means of notification upon actual receipt of delivery. All notices shall be addressed and delivered to the appropriate party at the addresses appearing in this agreement, or as the same may be changed in writing by either party in accordance with this paragraph.

LOST PROFITS

Under no circumstances shall NBDS, Inc. be liable for lost profits consequential or exemplary damages. NBDS, Inc.'s failure to enforce or failure to insist upon strict compliance of any terms of this agreement shall not constitute a waiver.

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