Fax this completed document back to EZCheck at: MERCHANT CLUB ENROLLMENT FORM EZCheck offers a care free maintenance program that covers your EZCheck POS equipment. ACCOUNT INFORMATION Company Name: Contact Name: Phone #: Address: City: State: Zip Code: Merchant ID: EQUIPMENT INFORMATION Terminal SN: Printer: SN Check Reader/Imager: SN: MERCHANT CLUB AGREEMENT I wish to enroll in the EZCheck Merchant Club Program. I understand that I will be billed a monthly Merchant Club fee of $7.00 on my EZCheck statement. I understand this fee is in addition to any monthly fees accepted under the EZCheck Merchant Agreement. I agree to pay an enrollment fee of $75.00 (plus shipping). Our Agreement: EZCheck will replace or repair equipment for Merchants that are members of the Merchant Club Program. A shipping fee of $29.95 will be charged per equipment item replaced. If replaced equipment is mailed to Merchant, it is Merchant’s responsibility to return defective equipment to EZCheck’s office within 7 business days or Merchant will be deemed to have purchased equipment and be billed, at EZCheck’s published price list, for such equipment. Equipment returned after 7 business days will be subject to a 50% restocking fee. A fee of $40.00 per hour plus the cost of parts will be charged for any repair or equipment beyond ordinary wear and tear. A reprogramming fee of $15.00 will be charged for each occasion that a piece of equipment is reprogrammed for additional features or different information. Merchant shall not permit persons other than authorized representatives of EZCheck to adjust, maintain, program or repair any equipment. Merchant shall bear the entire risk of loss, theft, or damage of or to equipment. There is a 90-day manufacturer’s warranty on sold equipment. All fees and charges are due and payable upon receipt. Unless otherwise agreed by EZCheck in writing, Merchant authorizes EZCheck to debit all payments owing to EZCheck under this Agreement and to credit all amounts owing to Merchant under this Agreement to Merchant’s ACH account. Authorized Signer Date Fax this completed document back to EZCheck at: (281) 599 9314 Please note: This document must be completely filled out in order to join EZCheck’s Merchant Club program. Incomplete applications will not be accepted. For assistance completing this application contact Technical Support at (800) 797 5302.