1. MERCHANT APPLICATION AND AGREEMENT
FAX BACK To: _______________
or
E-Mail BACK To: _______________
Sales Rep Telephone #: Fax #: N/A
BUSINESS INFORMATION
MERCHANT BUSINESS INFORMATION
Name of Entity (Legal Name): Nelly Wesley Name of Business: Nelly Wesley
Corporate / Billing Address: 2346 Haywood Avenue Location Address (No P.O. Box #): 2346 Haywood Avenue
City: West Vancouver Prov: BC Postal Code: v7v1x7 City: West Vancouver Prov: BC Postal Code: v7v1x7
Telephone # (Landline):
GST exempt: GST Tax ID: Telephone # (Landline):
Fax: Time Zone:
604-913-2479
604-913-2479
How long in present business? Year: Months: 4 Email (Statement):
nkathleenwesley@gmail.com
Attention: Allan Lacoste
Merchant Customer Service # (If MOTO/Ecomm): 604-913-2479 What descriptor would you like to appear on customer credit card statement?
Vemma Products
Previous Processor? Yes No Name of Previous Processor:
OWNERS OR OFFICERS (Ownership must be equal to or greater than 50%)
Title: Email address: nkathleenwesley@gmail.com Percent Ownership: 100%
First Name: Last Name: Date of Birth:
Home Address: 2346 Haywood Avenue City: West Vancouver Prov: BC Postal Code: v7v1x7
Home Tel. : 604-913-2479 SIN: 733038236 Driver Lic. : DL.2348967 Prov: BC
Cell. #:
Title: Email address: Percent Ownership:
First Name: Last Name: Date of Birth:
Home Address: City: Prov: Postal Code:
Home Tel. #: SIN: Driver Lic. #: Prov:
Cell. #:
ELECTRONIC DEBIT / CREDIT AUTHORIZATION
Please provide a pre-printed void business check or bank letter confirming your business account Transit # (ABA Routing) and Ac count# (DDA).
By providing this information, you are authorizing the Bank to initiate EFT debit and credit transactions to said account in ac cordance with section 5.09 of the TOS.
Bank ID: 1 Bank Transit Number: 7780 Account Holder Name: Wesley Group Networking Bank Account Number: 07788985-758
Bank Branch Postal Code: v7v1x7 Account Holder Name :
DEFINITIONS: "Merchant Application" means this Merchant Application between Peoples Trust, Pivotal Payments Direct and Merchant.
"Merchant Agreement" means this Merchant Application once approved and accepted by Peoples Trust together with the Terms of
Service ("TOS") found at www.pivotalpaymentsdirect.com/terms .
I confirm that I have read and understood the TOS and agree to all statements. Merchant initials:
PEOPLES TRUST DISCLOSURE MEMBER INFORMATION: Peoples Trust Company ("Peoples Trust")
Important Peoples Trust Responsibilities:
1. Peoples Trust is the only entity approved to extend
acceptance of Visa, MasterCard and Interac products directly
to a Merchant.
2. Peoples Trust is responsible for educating Merchant on
pertinent Visa, MasterCard, Interac operating regulations with
which Merchant must comply.
3. Peoples Trust, not Pivotal Payments Direct must hold,
administer and control all reserve funds derived from
settlement.
4. Peoples Trust, not Pivotal Payments Direct ust hold,
administer and control settlement funds for the Merchant.
5. Peoples Trust must be a principal (signor) to the Merchant
Agreement
Important Merchant Responsibilities:
1. Complying with cardholder data security and storage
requirements.
2. Maintaining fraud and chargebacks below established
thresholds.
3. Reviewing and understanding the TOS located on above
website.
4. Complying with Visa, MasterCard, Interac operating
regulations.
The responsibilities listed above do not supersede terms of the TOS but are provided to ensure the Merchant understands some important obligations of each party and that Peoples Trust,
as the Visa/MasterCard/Interac member, is the ultimate authority should the Merchant have any problems.
Signature 1: Title: Date: 2014-05-18
Signature 2: Title: Date: 2014-05-18
BUSINESS INFORMATION (CONT'D)
Agent Office / Inside Sales Rep Name: Allan Lacoste
URL: S.C.I: Product or Service being offered: Vemma Products
Nelly Wesley 1956-06-09

2. BUSINESS PROFILE SALES PROFILE
Type of Ownership : Sole Proprietorship Government
Partnership Limited Liability
Corporation Non-Profit
Merchant Type: Retail Internet Service
Restaurant MO/TO
Lodging Other Home Based
TRADE / REFERENCES 1 TRADE / REFERENCES 2
Company Name: Company Name:
Address: Address:
Contact : Title : Contact : Title :
Telephone : Ext.: Telephone : Ext.:
SEASONALITY
Do you operate Seasonally? Yes
January February March April May June
July August September October November December
DATA SECURITY & PCI COMPLIANCE
1. Do you store credit card numbers?
2. Do you use a third party application that transmits or processes cardholder data?
3. If credit card payment information is taken over the Internet is payment channel encrypted by SSL or better?
4. If merchant is an e-commerce merchant, is an SSL Merchant Certificate utilized?
If yes, please provide the following:
N/A Yes NO
N/A Yes NO
N/A Yes NO
N/A Yes NO
N/A Yes NO
If yes, please provide the following: Merchant Certificate: Certificate Issuer:
Exp. Date: Is Certificate? Individual Shared
* Merchant agrees to pay a quarterly data security fee of $ per terminal in consideration of Pivotal Payments moni toring, advising and implementing any Bank or card-Association
mandated changes to regulations
SITE SURVEY
Please complete as many of the following questions that are relevant to your business type. Not all questions are applicable to all business types. Please indicate Not-Applicable ( N/A ) in
such cases.
1. % of total card sales: Business to business 5% + Business to consumer 95% = 100%
2. How long after payment is product delivered or service fulfilled? or
0-7 days 100% + 8-14 days 0% + 15-30 days 0% + over 30 days0% = 100%
3. Visa/MasterCard/Discover card sales are charged to the card on: Date of order Date of delivery Other (specify): :
4. Who performs product / service fulfillment? My Company Vendor Other If vendor or other, add:
Name: Herbalife Contact name:
Address:
City: State/Province: Zip/Postal Code: Phone:
5. If your product is shipped, what delivery method do you use? (Ex. Regular Mail, Fedex, local delivery service):
Fedex
6. Does your business charge recurring billings to customers? N/A Yes No
7. Does any of your billing or marketing strategy involve negative response, or automatic billing? N/A Yes No If yes, please explain:
8. Do you require deposits? N/A Yes No If yes, % of total sale: % OR Flat fee: $ Is final payment due before fulfillment N/A Yes No . If yes, how many days before final delivery?
9. Do you have a refund policy, and if so, what is it? Yes,30 days return policy
10. What are your product/service guarantees or warrantees (if applicable)? If for any reason a retail customer is not satisfied with any Herblife product, we offer a full refund, excluding
shipping charges, if requested within 30 days of receipt of product.
11. Advertising method: Internet Catalog Direct Mail Phone book TV / radio Newspaper / Magazine Other (specify):
I confirm that i have read and understood all services subscribed and their associated rates
and fees, as well as Terms of Service found at www.pivotalpaymentsdirects.com/terms.
SCHEDULE A
VISA / MASTERCARD SALES PROFILE (be as accurate as possible or delays will occur in processing the application)
Card Swipe: % VISA MASTERCARD Debit
Keyed (In person): %
Monthly Volume: $ 2000 $ 400 $ N/A
MO/TO: 100%
Internet: 0%
(includes calculation of all 4 categories) Total = 100%
Average Ticket: $ 39.95 $ 39.95 $ N/A
VISA/MASTERCARD PROCESSING
VISA Mastercard
Credit Card Processing Minimum: $ / Month
Qualified
Transactions
$2.39 $2.39 $2.39 %
Mid-Qualified
Transactions
% 0.00 % % 0.00 %
Non-Qualified
Transactions
$4.35 $4.35 $4.35 %
Cost Plus % % % %
Quoted Merchant Rates may be subject to International Assessments on foreign issued
cards.
Associated Fees
Online Reporting / Web Fee $ / Month
Authorization Fee $ / Authorization
Clearing Fee $ / Transaction
Statement / Service Fee $ / Month
Batch Fee $ / Batch
Card Brand Fee on all Credit Card
%
Transaction Volume
MasterCard Cross Border Assessment Fee for
Foreign Card Volume
%
OTHER CARD TYPES
Existing Account New Account

3. SE # Auth. Fee Monthly Volume Rate Per Item
AMEX (10 digits) $ .10
AMEX Connectivity Fee: $ / month
DINERS CLUB (10 digits) $ .10
JCB $ .10
DEBIT SALES PROFILE
Monthly Volume: $ (be as accurate as possible or delays will occur in processing
Average Ticket: $ the application)
DEBIT PROCESSING
Debit Acceptance Debit Surcharge
Debit Card Processing Minimum: $ / Month Per transaction fee $
Debit: $ / Authorization Transaction Fee: $ / Transaction
SCHEDULE B
E-COMMERCE SERVICES
Standard VT Recurring VT Web Commerce Suite
Application Fee $64.95 $ $
Monthly Gateway Fee $54.95 $54.95 $
Fee per transaction $0.25 $ $0.25
CONFIGURATION PARAMETERS
Tip Function Yes No Retrieval Fee $ 10.00 / Transaction
Debit Auto Settle Yes No If yes, what time? Chargeback Fee $ 25.00 / Occurrence
Password Protect refunds? Yes No Cash Back Fee Amount $ _ Account Setup Fee $ 0.00
Allow Debit Cash Back Yes No Anniversary Fee $ 99.95 / Year
MCP Yes No Application Fee $ 0.00 / Item
DCC
I confirm that i have read and understood all services subscribed and their associated rates
and fees, as well as Terms of Service found at www.pivotalpaymentsdirects.com/terms.
AGREEMENT
PERSONAL GUARANTY
The undersigned individually, absolutely and unconditionally guarantees to Pivotal Payments Direct ("PPD") the prompt payment of all amounts due under this Merchant Agreement (i.e.
this Application and the TOS) including all attorney's fees and costs associated with enforcement of this personal guaranty. PPD shall not be required to proceed against Merchant or
enforce any other remedy before proceeding against the undersigned. This is a continuing guaranty and shall bind the undersigned's heirs, successors and assigns. The undersigned
consents to any extension or modification of this application and TOS. The release or compromise of any obligation of Merchant or an other obligors/guarantors shall not release the
undersigned from its obligations under this personal guaranty.
Signature #1 Title
Print Name Nelly Wesley Date 2014-05-18
Signature #2 Title
Print Name Nelly Wesley Date 2014-05-18
ACKNOWLEDGEMENT.
Merchant certifies that all information set forth in this Merchant Application is true and correct and that it has read and agreed to all terms of the Terms of Service (TOS)
located at www.pivotalpaymentsdirect.com/tos, incorporated herein by reference. Merchant agrees and acknowledges that the below signature serves as consent to the Equipment
Lease Agreement found in the Third-Party Agreements section of the TOS, if selected above. This Merchant Application together with the TOS constitute the Merchant Agreement.
Merchant, its representative(s) and each person whose information is on this Merchant Application authorizes PPD, Peoples Trust and their agents prior to acceptance of this application
and from time to time: (i) to investigate the individual and business history, creditworthiness and background of Merchant, each such representatives and any other officers, employees,
partners or owners of Merchant (collectively Merchant Principals); (ii) to obtain credit reports, financial information or other background reports on each of the Merchant Principals; (iii) to
use personal information provided in this Merchant Application to facilitate provision of services hereunder; (iv) to use and share such personal information with financial institutions,
payment card issuers, credit agencies and similar agencies for reporting purposes and for investigating fraudulent or suspicious activities regarding Merchant account. Merchant agrees to
all the terms of this Merchant Application and the TOS.
Merchant acknowledges that this Merchant Application and the TOS shall not take effect until Merchant has been approved by PPD and Peoples Trust as evidenced by the issuance of a
merchant identification number. By signing below, I represent that I have read and am duly authorized to sign and submit this Merchant Application for the above business (Merchant) and
that I have read and agreed to the terms of the TOS.
MERCHANT: PEOPLES TRUST COMPANY (BANK):
Principal #1 Signature X: By:
Print Name: Nelly Wesley
Date:2014-05-18
Name and Title:
MERCHANT: PIVOTAL PAYMENTS DIRECT CORP.:
Principal #1 Signature X: By:
Print Name:
Name and Title:
Date:

4. No Image Uploaded
This check identifies the account from which Pivotal Payments Direct is authorized to initiate credit and debit entries as per the Pre-Authorized Debits (PAD) section in the Merchant
Agreement.
*** SECTION BELOW TO BE COMPLETED ONLY IF THE COMPANY NAME IS NOT PRINTED ON THE VOID CHECK ***
MERCHANT INFORMATION AND AUTHORIZATION
I hereby authorize my bank (referenced above) to confirm to Pivotal Payments Direct that this check is linked to an active bank account.
Company Name: Nelly Wesley
Name of Signing Officer: Nelly Wesley
Merchant Name: Nelly Wesley
Signature: Date: 2014-05-18 IP Address: 23.16.224.25
BANK CONFIRMATION (FOR BANK USE ONLY)
Attention:
Dear Sir/Madame, our mutual client has applied to Pivotal Payments Direct for merchant services. Kindly sign and stamp below (both are required) in order to confirm that the
account above is active and valid. Once completed please return by fax to:
Bank Representative Name:
Phone # :
Signature:
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