192900 12/15/2010 CITY OF CARMFL, INDIANA VENDOR: 364941 Page 1 of 1
ONE CIVIC SQUARE R B S WORLDPAY CHECK AMOUNT: $75.00
?o CARMEL, INDIANA 46032
CHECK NUMBER: 192900
CHECK DATE: 1211512010
DEPARTMENT AC PO NUMBER INVOICE N UMBER AMOUNT DESCRIPTION
1091 4341999 75.00 OTHER PROFESSIONAL FE
Carmel e Clay
Parks &Recreation CHECK REQUEST
Date: December 1 2010
Check payable _t_o
Name: RBS WorldPay
Address: 3800 Camp Creek Pk
City, State, Zip Atlanta GA 30331
Mail check to payee XX Return check to requestor
Check Amount 75.00 Date Required 12/17/2010
Check needed for Credit Card Merchant services Gate way to connect to
Processing network
To be paid from
PO (if applicable) NA
Budget account GL 1091 4341999
Budget Line Description Other Professiona fees
Invoice(s) and Purchase Order (if required) MUST be attached.
Requested by (print): Paula Schlemmer
Requested by (signature): it id
Approved by (signature of ivision Manager);
on this date h
Form revised 7 -7 -08 Shared Administrative Forms Staff forms 1 Check Request (rev 7 -7 -08)
VW BS WorldPdy/ PAYMENT FORM
Customer Legal Names Ca rm e l Clay Parks and Recreation 1 EEI
Sales Order No.
�a aa �r m
E a z Description Qt
a E P Y Price Total
x a (7 Per Unit
a L U
M U
iW'
0 0 0 O O 0 .S 10 IAuthorize.Net (Gateway) One Time Set -up fee 1 175.00 1 -00
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New equipment urchased from RIBS WorldPa m be returned within 30 d of original shi date providing the unit (s)
P Y Y Y P P 9 O
is/are boxed in original packaging and unmarked. A $25 restocking fee and shipping costs will apply.
R. Exchanges are for like devices (same model numbers and memory capacity) and the returned device(s) must be Total Equipment Price 175.00
in full working order or the exchanged device(s) will be charged to merchant's account at the full retail price.
Paid in Full or �0 Down Payment (Select One) Equipment Price 175.90 1
k (Shipping and Handling Not Induded)
r Paid by Check: Check Number I I
n
Non- Refundable Application Fee i
Paid by ACH
„e..
ACH I; I: II Other t
a Bank Routing Transit No. Checking Account No.
r 0 Paid by Credit Card: Gift Cards I
m 1
jk
f Expiration Date (MM YY) Rush Fee t I
�S"M
Installments (Note: Required section if Down Payment is selected) Subtotal 1750()
1
t ACH 1:1 1 1 li II'
Bank Routing Transit No. Checking Account No. Tax i I
1511 Balance due of 1 I will be paid in three (3) equal installments of I via ACH
TOTAL DUE 175.00
t
Notes:
Less Down Payment t
t Balance Du 75.00
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��utR�.
n'4 The Undersigned hereby authorizes RBS WorldPa to electronical draft via the Federal Automated Clearing house ACH s
9 Y Y Y 9 (ACH) the amount indicated above and, Y
if applicable. all installment payments from the account identified by Customer herein or have the fees described above charged to signer's credit card as indicated.
Down payment is due with this Agreement. Installment payment will be collected by ACH draft 30, 60 and 90 days from the date of this Agreement.
I AGREED AND ACCEPTED BY CUSTOMER
11l 1 ��l�f�l 1 2l C SS 1 f CC -T �a
(Autho 1 gnature) (Print Name) (Title) yµ (Date)
Payment Form 3073 (03 110)
Audrey Kostrzewa
Subject: FW: WorldPay Merchant Services/Carmel Clay Parks
From: Rallah Phillips [mailto:Rallah.Phillips@WorldPay.us]
Sent: Wednesday, December 01, 2010 9:49 AM
To: Audrey Kostrzewa
Subject: RE: WorldPay Merchant Services/Carmel Clay Parks
Good morning, R,9.5 LJ. r
Please send checks payable to WorldPay to 3800 Camp Creek Pkwy, Atlanta, GA 30331 ATTN:
Rallah Phillips
Thank you,
Rallah Phillips I BankCard Consultant Central Sales lWorldPay- Citizen's Merchant Services
T (866) 232 8691 ext. 4768 1 F (800) 966-5965
3800 Camp Oreek Pkwy I Atlanta GA 30331 1 US
worldpay.us
"Make It Happen"
PRIVILEGED AND CONFIDENTIAL COMMUNICATION NOTICE. The information contained in this e-mail message is legally privileged and confidential,
and is intended solely for the use of the addressee. Any unauthorized dissemination, distribution or copying of this e-mail is expressly prohibited. If
you have received this e-mail message in error, please notify the sender immediately and delete this message and any attachments,
From: Rallah Phillips [mailto:Rallah.Phillips@WorldPay.us]
Sent: Monday, November 29, 2010 1:27 PM
To: Audrey Kostrzewa
Subject: RE: WorldPay Merchant Services/Carmel Clay Parks
Audrey,
Considering gateways are a virtual service, I am not quite sure what sort of
documentation would be available/valuable. I have attached the only customer-facing
document.regarding Authorize.net... Let me know if the following information is
incomplete.-Thank you
Per our conversation:
Authorize.net has a one-time set-up fee of $75.00 and a monthly recurring fee of
$15.00/mo
Authorize.net is the gateway that connects the site's shopping cart to our
processing network.
Authorize.net allows any shopping cart to be utilized.
There are no set-up fees to establish an additional LK number (location), and the
per transaction rates will be a mirror image of your current rates.
You are currently receiving cost-plus pricing.
You do not pay any monthly administration fees to WorldPay
I am the person who will establish the new AmEx account for the website.
AmEx always sets their rate. The rate you will receive is 2.89% $0.25 per
transaction.
There are no additional steps necessary on your end to establish this new
AmEx account.
Thank you,
Rallah Phillips I BankCard Consultant Central Sales lWorldPay- Citizen's Merchant Services
T (866) 232 8691 ext. 4768 1 F (800) 966 -5965
3800 Camp Oreek Pkwy I Atlanta GA 30331 1 US
worldpay.us
"Make It Happen"
PRIVILEGED AND CONFIDENTIAL COMMUNICATION NOTICE. The information contained in this e-mail message is legally privileged and confidential,
and is intended solely for the use of the addressee. Any unauthorized dissemination, distribution or copying of this e-mail is expressly prohibited. If
you have received this e-mail message in error, please notify the sender immediately and delete this message and any attachments.
From: Audrey. Kostrzeoura [mailto :audreyk @carmelclayparks.com]
Sent: Monday, November 29, 2010 12:50 PM
To: Rallah Phillips
Subject: RE: WorldPay Merchant Services /Carmel Clay Parks
RE: Customer #1000424622
lQu n a,fi
Rallah, C,4=Aj :7 4 n e alCkS1 7c. G
We are In the final stages of our new website development. I have received the Pay Form you sent for Authorize.net. It ��f(
would be helpful to me if I had more documentation about the pricing for this gateway service in order to request a
check.
Please, email the information that we discussed by phone, as you indicated you would:
Authorize.net pricing
New RBS merchant location Pricing for setup and processing
Are you also able to set up a new AmExp account for this new website, or do I need to contact them? Please send
detailed info and pricing if you can handle that as well.
Audrey Kostrzewa
Business Services Division Manager
Carmel Clay Parks Recreation
Administrative Offices
1411 E. 116th Street
Carmel, IN 46032
P 317.573.4021
F 317.571.4136
audreyk @carmelclayparks.com
www,carmelclayparks.com
2
From: Rallah Phillips [ma ilto Rallah. Phillips @World Pay. us]
Sent: Monday, November 29, 2010 11:42 AM
To: Audrey Kostrzewa
Subject: WorldPay Merchant Services
Hi Audrey,
Please find terminal payment form attached. The only additional information T will need
is the website address... Let me know if the payment form does not suffice. Talk to you
soon.
Thank you,
Rallah Phillips I BankCard Consultant Central Sales JWorldPay- Citizen's Merchant Services
T (866) 232 8691 ext. 4768 1 F (800) 966 -5965
3800 Camp Oreek Pkwy I Atlanta GA 30331 1 US
worldpay.us
"Make It Happen"
PRIVILEGED AND CONFIDENTIAL COMMUNICATION NOTICE. The information contained in this e-mail message is legally privileged and confidential,
and is intended solely for the use of the addressee. Any unauthorized dissemination, distribution or copying of this e-mail is expressly prohibited. If
you have received this e-mail message in error, please notify the sender immediately and delete this message and any attachments.
3
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No,
RBS WorldPay Terms
3800 Camp Creek Pkwy
Atlanta, GA 30331
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1211110 Ck Request Gateway for new website CC processing 75.00
Total 75.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
RBS World Pay Allowed 20
3800 Camp Creek Pkwy
Atlanta, GA 30331
in Sum of
75.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
i
1091 Ck Request 4341999 75.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
9 -Dec 2010
A Le2
Signature
75.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund