ValuCard - United States Bankcard Service

ValuCard
INTERNATIONAL
This Addendum is made and entered into date signed below by and between ValuCard, a California
Corporation (hereinafter referred to as “DISTRIBUTOR”), and client listed below who is located at
the address below hereinafter referred to as client.
Office Use Only:
CLIENT DBA BUSINESS INFORMATION
File No,__________ Rep ID__________MID______________________
LEGAL ADDRESS/BILLING INFO
DBA Name
Legal Name/Billing Info
DBA Street Address
Address
City
State
Zip
Phone
Fax
Tax ID Number
Number Of Approved Locations
City
State
Phone
Fax
Zip
SERVICES - CHOOSE YOUR PACKAGE
… INTRODUCTION
… BRONZE
Set-Up Cost:
Number of Cards:
FREE
30
Cost of Cards
Artwork/Layout:
FREE
TEMPLATES
… SILVER
$25.00
250
Set-Up Cost:
Number of
Cards:
Cost of Cards
Artwork/Layout:
$0.68/Card
TEMPLATES
$99.95
500
Set-Up Cost:
Number of
Cards:
Cost of Cards
Artwork/Layout
TEMPLATE INFO (See Website for additional TEMPLATE INFO)
Your Custom Info for Template
… Template A
… Template B
… Template C
… Template D
… Template E
… Template F
… GOLD
$0.58/Card
CUSTOM
Set-Up Cost:
Number of
Cards:
Cost of Cards
Artwork/Layout:
$99.95
1000
$0.48/Card
CUSTOM
Bank Account Info
Bank Name
Line 1:_______________________________________
Line 2:_______________________________________
Branch Name/Location
Routing Number/ABA
Account Number/DDA
STORED VALUE – SERVICES/FEE SCHEDULE*
One Time Application $_______ Monthly Service Fee $_______ Per Transaction Fee $______ Custom Graphic Design Fee $______
*Stored Value – Services/Fee Schedule may be amended from time to time without prior notice. Client will be notified to such amendments 30 days prior to implementation. An Annual Postage Fee of $35.00 will be
assessed. In the event of early termination, a $195.99 Termination Fee will be assessed. By your signature below, you hereby agree to all the Stored Value- Services/Fee Schedule listed above and authorize ValuCard
International (DISTRIBUTOR) to initiate debit entries to the Client’s checking account(s) in accordance to the Services/Fee Schedules detailed above.
DISTRIBUTOR has entered into an Agreement with OPTICARD, INC., a Delaware corporation (hereinafter referred to as “Opticard”) to provide prepaid service for it. The service together with its related software and
documentation integrates with various retail store locations to provide a prepaid/stored value tracking system for anonymous customer activity at the retail business. The service shall hereinafter be referred to as the
“Opticard” product. DISTRIBUTOR’s Client desires to initially purchase processing for the number of Opticard activations specified above. Each Opticard issued will contain an account number and magnetic stripe
encoded to Opticard’s specifications and an approved Opticard logo will be incorporated into the design of the card. DISTRIBUTOR’s Client is granted the use of the Opticard product at the number of locations specified
above. The fees and payments required under the terms of this Addendum are listed above.
CLIENT OWNER/OFFICER INFORMATION
Client Principal
Date of Birth
Social Security Number
Residential Address
City
State
ZIP
Home Phone
Home FAX
Time at Address
Do You
Driver’s License Number
Expiration Date
Owner %
Title
… OWN … RENT
This Addendum shall be effective upon the date hereof for a term of 36 months. This addendum will automatically renew for additional one (1) year terms, unless notice is provided in
writing by DISTRIBUTOR’s Client 60 days prior to the termination of the addendum. As long as this addendum is in force, all Opticards on the system shall continue to be maintained. In
the event of the termination of this Addendum and upon the request of DISTRIBUTOR’s Client, Opticard shall provide a un-load of the existing cards in the Opticard database.
Client Principal Signature
Title
Date
X_________________________________________________________________________________________________________________________________
Signing for Distributor
Title
Date
X_________________________________________________________________________________________________________________________________
DISTRIBUTOR: ValuCard International – 5716 Corsa Ave Suite 208, Westlake Village, CA 91362 – PH: 800-806-1226 FX: 800-344-3495
EQUIPMENT SET-UP INFO
Terminal Manufacturer
Application
Terminal Model
Printer
Platform
Rev. 03/06
Gift Card Proposal
Merchant Name__________________________________Business Name__________________________Date__________
Phone:________________________Office:__________________________Sales Person____________________________
Introduction Gift Card Package
30 Pre-Designed Gift Cards
Merchants will receive one
acyrlic card holder display and
equivelant number of
card envelopes with all orders.
Pre-Designed Options
A
with the merchants DBA printed on cards
Marketing Kit, Card Sleeves & Envelopes
B
Setup $0.00 Cost Per Card $0.00
Bronze Gift Card Package
250 Pre-Designed Gift Cards
with up to two lines of text on cards
C
Marketing Kit, Card Sleeves & Envelopes
Setup $25.00
Cost Per Card $0.68
Silver Gift Card Package
500 Custom Designed Gift Cards
Merchants will receive one
acyrlic card holder display and
equivelant number of
card envelopes with all orders.
D
Custom Card Graphics
Marketing Kit, Card Sleeves & Envelopes
Setup $99.00 Cost Per Card $0.58
E
Gold Gift Card Package
1000 Custom Designed Gift Cards
Custom Card Graphics
Marketing Kit, Card Sleeves & Envelopes
Setup $99.00 Cost Per Card $0.48
F