Transfer Agreement Form

This Transfer Agreement Form is to acknowledge and establish Palm Beach Financial Exchange, Inc. to act as the agent of the business listed for the purpose of recurring transaction payment processing. This form is required for EACH owner of the business if PERCENTAGE OWNERSHIP is less than 100%. Additional Owners/Officer forms are required until a percentage greater than 50% ownership has been submitted. Two Corporate Officers with corporate account establishing authorizations are required for widely held entities.

Step 1 of 3

* ALL SENSITIVE INFORMATION IS ENCRYPTED FOR YOUR SECURITY AND NOT SHARED WITH ANY OTHER ENTITY.
BUSINESS INFORMATION
Business Name (DBA):*
Enter the name of the business.
Business Phone:*
Enter the business telephone number.
Business Website:
Enter the business website address.
Contact Name:*
Enter the billing contact name.
First Last
Contact Email Address:*
Enter the billing contact email address.
Enter Email Confirm Email
Business Address:*
Enter your business address.

Street Address Address Line 2 City State ZIP Code
Goods/Services:*
Select the nature of the business.
EIN - Tax ID*
Enter the Employer - Tax Id number.
Business Start Date:*
Enter the start/inc. date of the business.
Business Organization Type:*
Select the business organization type.
Incorporation State:*
Enter the state of incorporation/charter.
Corporation Name:*
Enter the name of your corporation.
Corporate Phone:*
Enter the corporate phone.
Contact Email:*
Corporate contact email.
Corporate Address:*
Corporate Address same as Business Address

Street Address Address Line 2 City State ZIP Code
Corporate Contact:*
Enter the corporate contact name.
First Last
Contact Title:*
Enter contact title.

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OWNER/OFFICER INFORMATION
Owner/Officer:*
Enter the name of the Owner/Officer.
First Last
Owner/Officer Tittle:*
Enter the business tittle of the Owner/Officer.
Ownership Percentage:*
Enter the % ownership of the Owner/Officer.
Please enter a number from 0 to 100.
Owner/Officer D.O.B.:*
Enter the Date of Birth for Owner/Officer.
Social Security Number:*
Enter the Owner/Officer's Soc. Sec. Number.
Owner/Officer Email Address:*
Enter the Owner/Officer email.
Owner/Officer Residence Address:*
Enter the residence address of Owner/Officer.

Street Address Address Line 2 City State ZIP Code
Residence LESS THAN 5 Years:*
Select YES/NO if the current residential address is LESS THAN 5 YEARS.
- NO - The current address is 5 Years or Greater
- YES - The Current address is LESS THAN 5 Years.
Former Residence Address IF LESS THAN 5 YEARS:*
Enter the residence address of Owner/Officer if the current residence address is less than 5 years..

Street Address Address Line 2 City State ZIP Code
Owner/Officer Driver's License Number:*
Enter Owner/Officer driver's license number.
Driver's Licence Issueing State:*
Enter the issuing state of driver's license.
Owner/Officer Height:*
Enter the Height of Owner/Officer.
Owner/Officer Mobile Phone:*
Enter the Owner/Officer mobile number.
Owner/Officer Home Phone:
Enter the Owner/Officer home phone.

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PBFE AUTHORIZATION
Consent to Bank Account Activity:*
This ELECTRONIC FUNDS TRANSFER AGREEMENT by and between the above named business ("MERCHANT") and PALM BEACH FINANCIAL EXCHANGE, INC. ("PBFE"), becomes effective upon the MERCHANT's signature being affixed hereto.

MERCHANT hereby authorizes PBFE in accordance with this Processing Agreement to initiate debit/credit entries to the MERCHANT customers' checking accounts, savings accounts, and/or credit cards for the purposes of rendering payment for MERCHANT's goods and/or services.

MERCHANT is solely responsible for any and all activity to the MERCHANT customers' checking, savings accounts, and/or credit cards and in no manner or form shall PBFE be liable for any entry to said accounts. PBFE acts merely as the processing agent for MERCHANT and conducts all activities based upon the instructions of MERCHANT. This Authority is to remain in full force and effect until PBFE has received written notification from MERCHANT of its' termination in such a manner as to afford PBFE reasonable opportunity to act on said termination and all obligations of Merchant to PBFE that have arisen under this AGREEMENT have been paid in full including but not limited to, those obligations of outstanding returns for non collectable debits. MERCHANT's Reserve account balance will be disbursed 60 days after MERCHANT's last debit.

PBFE reserves the right to terminate this Agreement at any time. For Value Received, and in consideration for the undertakings contained in the ELECTRONIC FUNDS TRANSFER AGREEMENT by and between MERCHANT and PBFE, the undersigned jointly, and severally if more than one, unconditionally guarantees to PBFE, its successors and assigns, the full and prompt payment when due of all of the obligations of every kind and nature of MERCHANT arising directly or indirectly out of this Agreement or any document or agreement executed and delivered by MERCHANT in accordance with the terms of this Agreement. The undersigned further agrees to pay PBFE all expenses (including attorneys' fees and court costs) paid or incurred by PBFE including such obligations, and enforcing this Guaranty. This Agreement and Guaranty shall be governed in accordance with the laws of the State of Florida.

TERMS AND CONDITIONS
Terms and Conditions governing this agreement between the Merchant (the Originator) named in this Electronic Funds Transfer Agreement and PBFE and its officers, employees, affiliates, licensees and agents:

WHEREAS: Merchant desires PBFE, and PBFE agrees, to provide Automated Clearing House (ACH) and/other merchant services to Merchant as indicated in this agreement. Transactions are placed through PBFE as third party ACH transactions, paper draft or IRD checks. PBFE will send all transactions through an Origination Depository Financial Institution (ODFI) in accordance with the terms of this Agreement, the Operating Rules (Rules) of the National Automated Clearing House Association (NACHA) and the applicable Federal Regulations governing ACH transactions. Entry or Entries shall mean either Credit Entries, a Debit Entries, a paper draft or an IRD as appropriate. Merchant also agrees to comply with all rules at the time each entry is initiated by the Merchant with respect to the most recent NACHA operating rules and that each entry shall in no way breach any Federal, State, or Local statute of regulation pertaining to and for electronic funds transfers, including the Electronic Funds Transfer Act and Regulation E, and all other applicable laws and regulations. Merchant understands that a violation of any NACHA rules may result in fines issued by NACHA for said violations and said fines will be passed on to Merchant. You will comply with PBFE’s requests for record retention and signature authorization. You grant to PBFE or our designee the right to audit these authorizations and your record retention compliance, at no expense to us.
Account Authority
Submitted By:*
Name of the person submitting this banking information.
First Last
Date Submitted:*
Date information submittal.
Comments
This field is for validation purposes and should be left unchanged.

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Transfer Agreement Form

Step 1 of 3

* ALL SENSITIVE INFORMATION IS ENCRYPTED FOR YOUR SECURITY AND NOT SHARED WITH ANY OTHER ENTITY.

BUSINESS INFORMATION

OWNER/OFFICER INFORMATION

PBFE AUTHORIZATION