Bulkcardholder Application Form

BULKCARDHOLDER APPLICATION FORM

Recitals

WHEREAS, Issuer Name: is engaged in the issuance and management of bulk electronic payment cards; and

WHEREAS, Applicant Name: seeks to obtain bulkcardholder accounts for distribution to its cardholders under the terms set forth below;

WHEREAS, the parties desire to set forth the application details, operational parameters, payment obligations and mutual obligations in a binding agreement.

Applicant Information

Corporation LLC Partnership Other:

Program Summary and Scope of Work

Program Name:   Requested Effective Date:

Card and Funding Details

Payment Terms

Setup Fee:   Per-Card Fee (one-time):

Recurring Monthly Fee:   Transaction Fee (per transaction):

Invoice Frequency:   Payment Terms (due days):

Late Fee / Interest: Applicant agrees that overdue payments will incur a late fee of or the maximum permitted by law, whichever is less.

Compliance, Representations and Certifications

Applicant certifies that it will collect and maintain required identification and verification information for each cardholder consistent with applicable anti-money laundering laws and card network rules. Applicant will promptly provide, upon request, reasonable documentation to support KYC/AML compliance.

Applicant represents and warrants that it is not subject to any sanction, prohibition or debarment that would impair its ability to perform under this agreement, and that the information supplied in this application is true, accurate and complete to the best of Applicant's knowledge.

Term and Termination

Term Start Date:   Term End Date (if any):

Either party may terminate this agreement for convenience upon days' written notice. Either party may terminate immediately for material breach, insolvency, regulatory prohibition or repeated non‑compliance after written notice and a reasonable cure period where required.

Confidentiality

Each party shall treat as confidential all non-public information disclosed by the other party in connection with this application and subsequent services. Confidential information shall not be disclosed except to employees, contractors, auditors or advisors with a need to know, and who are subject to confidentiality obligations at least as protective as those contained herein. Confidential obligations survive termination for a period of three years except for trade secrets, which remain protected as long as permitted by law.

Indemnification

Applicant agrees to indemnify, defend and hold harmless Issuer and its affiliates from and against any loss, liability, claim, damage or expense (including reasonable attorneys' fees) arising from Applicant's breach of representations, misuse of cardholder accounts, failure to comply with applicable law, or negligent acts or omissions in connection with the Program.

Governing Law and Entire Agreement

This application and any resulting agreement shall be governed by the laws of the state specified below without regard to conflict of law principles. Governing State:

This document, together with any schedules or executed fee letters, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, representations and understandings, whether written or oral.

Miscellaneous Provisions

Notices: All notices required or permitted by this agreement shall be in writing and delivered to the contact information provided in this application. Assignment: Neither party may assign this agreement without the prior written consent of the other, except that Issuer may assign to an affiliate or successor in connection with a sale of substantially all of its assets.

Acknowledgment and Signature

By signing below, Applicant certifies that the information provided in this application is true and correct, and acknowledges that execution of this application constitutes Applicant's agreement to be bound by the terms contained herein and any subsequently executed service agreement with Issuer.

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