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APPENDIX "A" <br />PARTICIPATION AGREEMENT <br />This Participation Agreelnent ('Agreement")is by and between <br />Participant Narne: <br />Address: <br />City,State,Zip: <br />Main Voice Phone: <br />Web Address: <br />referred to herein as "ParticipanP and Govemment Payment Service,Jac.(d/bîa GovPayNet ,a Delaware <br />corporadon having a principal place of business at 7102 Lakeview Parkway West Drive,Indianapolis,Indiana <br />46268 ("GPSS <br />WHERL%GPS has assembled and supports the "GovPayNet Payment Network,"consisting of govemmental <br />entities (bat have each contracted witit GPS to accept payments on their behalf made by gardholders through GPS;and <br />WHEREAS,GPS accepts credit cards and debit carde carrying the American Express ,Discovef,MastutCattf and <br />Visa*bands from cardholders and,in accordance with the rules sad requimmems of such eredit and debit card <br />cámpaniK eneuterpaÿurents médetyliése cafdhdidets to padi¢ipants hi die GovPuyNet Paymentlietworkrand <br />WHERFAS,in order to improve Participant services and enhance administration,Farticipant desires to join the <br />GovPayNet Payment Network and accept payments kom GPS,with such support services sa GPS provides; <br />NOW,TKE1ŒFORE,in consideratton of the muinal provisions contained herein and other good and valuable <br />consideration,die reedpt and adequaey of which are hereby âgimewledged,Participant and GPS agree as follows: <br />L Recitals. <br />The above recitals are by this reference incorporated imo and madea part of this Agreement <br />1--alM,eeeme-effergve sepen-the4 posseesten <br />and eentianeder-Eve-yearesentenuttieany-renewing-foradditional-ene-yOBE-p EmÎRO <br />earlierne-presided4terein: <br />dater-(b-)-upea-30-4aye-mitten-aatlee-i€-Padisipaa-faik-wit -GP-S-pmeedam4w <br />pasielpadag-in-&e-CovaayNet--Paymenadetwere-et-fa}-innaediately-ifPartielpant-faikasempty <br />víd-anyetheNean-ef-this-Agreement- <br />GPS Agreement bio.ST-PATUClPANTK Œ,10YYMMDD Page l of 6 <br />'GPSP&vernmenux,füßNOV26)