Volume Card and Fundraiser Order Form

VOLUME CARD & FUNDRAISER ORDER FORM

Please fax your completed form to VPS at 305.670.9586 | DO NOT E-MAIL THIS FORM

Purchaser Information

Name:

Company Name:

Address:

Address:

City: State: Zip:

Phone: E-Mail:

Federal Tax ID/BN# (required for fundraisers):

Referring SUBWAY Store #:

Ordering Information

Min. Order: 10 Cards | Min. Card Load: $5 | Min. Total Order: $250 | Max. Card Load: $100

BULK ORDER DISCOUNT - Save 2% on any order of $5,000 or more.*

FUNDRAISER BULK DISCOUNT - Save 6% on any order of $500 or more.*

Must provide a valid 501(c)(3) Tax Exempt #

* Not applicable on purchases made with a credit card

• When ordering multiple currencies, please submit separate order forms for each currency.

Cards will be loaded with either U.S. or Canadian Dollars however, cards can be used in either country.

The Point-of-Sale system will automatically convert currency at the time of transaction based on established exchange rates. **Bilingual Cards are intended for use in Canada.

Specify Funds To Be Loaded $US $CANADA

Shipping Information

Allow 2-3 days for order processing prior to shipping.

Shipping is available to one address only.

Orders are not processed until payment is confirmed.

*Overnight orders must be received no later than 11:00 am Eastern for order to be processed for delivery.

Shipping Information

Name:

Company Name:

Address:

Address:

City: State: Zip:

Phone: E-Mail:

Payment Information

Credit Card Payment*

* (Limit $5,000. For orders over this amount please use another payment method.)

Name on Card:

Address:

Address:

City: State: Zip:

Phone: E-Mail:

Card #:

Expiration #: / Security #:

Authorized Signature:

ACH AVAILABLE ONLY IN THE U.S.

* (Fax to 305.670.9586)

Account #: ABA#:

Name on Account:

Authorized Signature:

I hearby authorize VPS LLC to initiate a debit transaction for the order total amount from the account specified above.

FAF

Program Description:

Market #: Program Timing:

COMPANY CHECK or MONEY ORDER

Make Checks Payable to: Value Pay Services

Mail Order Form with payment to:

SUBWAY CARD PROGRAM

Value Pay Services LLC | ATTN: Corporate Sales

9200 S. Dadeland Blvd. Suite 705 | Miami, FL 33156

All orders are NOT processed until payment is confirmed. All bulk order Card sales are final. No return and no refunds. Cards are shipped inactive as a safeguard against unauthorized use in the event cards are lost or stolen. Buyer is required to submit an activation request form to VPS to confirm delivery of order so that cards can be activated prior to use. Card activation takes 24-48 business hours from VPS’ receipt of your activation form. Card balances do not expire or decline with non-use nor are there any fees or service charges associated with dormancy. SUBWAY® Cards can be used in the United States, Canada, Puerto Rico, Guam and Saipan at this time.

When, where and how will these cards be used or distributed and will there be any promotional or marketing materials created?

Internal VPS use only

501(c)(3) Tax Exempt # Verification

IPC: