EFTPOS Application (Please fill out one EFTPOS application per ABN)

This form can be electronically filled out, printed and signed. Please return to salesenquiry@tyro.com or fax to 02 8907 1777

Tyro EFTPOS Application MYOB 2014-02-26Tyro Payments Limited ABN 49 103 575 042

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EFTPOS Price Schedule

(Tick appropriate box)

Based on your indicated volume of

your rates are:

Mobile No

<5m >50%<50%MOTO: Mail Order Telephone Order <10m <50m >50m

Last NameFirst Name

Postcode

2 1 L E TT E R S M A X

Business Phone No

Business Description

Annual Gross Revenue

Amex Merchant No

Diners Merchant No

ISO Agent

Prior EFTPOS Facility(For the last 12 months)

Trading Name(To appear on EFTPOS receipt)

Street(Trading address)

Suburb(Trading address)

Admin Contact

ABN

Company Name(As per ABN below)

State

(For online access and notifications)Admin Email Address

What is your Visa/Mastercard/eftpos & turnover per year?

If the terminal(s) is(are) to be delivered to a different address please inform your Tyro Sales Representative.

Name of yourTyro SalesRepresentative

YES NODo you have Broadband Internet Access at your location / outlet?

Member of corp. franchise/buying group

Recent bank statement or copy of current lease agreement for trading premisesrequired.

Recent merchant servicestatement required.YES NO

eftpos Debit Card with Cash-out

eftpos Debit Card for transactions of $15 and above

eftpos Debit Card for low-value transactions less than $15

MasterCard Debit Card Micropayments equal to or less than $15

Visa/MasterCard Domestic Consumer Credit Card

Visa/MasterCard Domestic Consumer Electronic Debit Card

Visa/MasterCard International Card

Visa/MasterCard Domestic Premium and Commercial Card

Visa/MasterCard International Credit swiped DCC commission

1

1

1

1,2

1

>$100,000 p.a.

standalone

inte-grated

inte-grated

standalone

>$300,000 p.a.

inte-grated

standalone

>$500,000 p.a.

$0.43$0.33

$0.00$0.00

$0.19$0.14

$0.19$0.14

0.96%0.86%

1.64% 1.74%

$0.60$0.50

-0.70% -0.70%

2.32%2.22%

$0.30 $0.38

$0.00 $0.00

$0.13 $0.17

$0.17$0.13

0.81% 0.89%

$0.58$0.50

-0.80% -0.80%

2.25%2.17%

1.59% 1.67%

$0.34$0.28

$0.00$0.00

$0.15$0.12

$0.15$0.12

0.85%0.79%

$0.54$0.48

-0.90% -0.90%

2.21%2.15%

1.57% 1.63%

Visa/MasterCard international transactions incur an international Service Assessment Fee of 0.40%, plus an additional 0.40% in case of DCC.Visa/MasterCard card-not-present transactions like MOTO or online payments incur an additional fee of 0.15%.1

2Merchants who accept Amex/JCB and Diners will pay the agreed upon Merchant Service Fees directly to these schemes, not to Tyro. Tyro applies a switching fee of only 0.10% to all Amex/JCB and Diners transactions processed through its terminals.

EFTPOS Terminals

XENTA Desktop Model with Ethernet Connectivityincluding 2m Ethernet Cable

XENTA Desktop Model with Ethernet and GPRS Connectivity including 2m Ethernet Cable

XENTISSIMO Wireless Handheld Model with GPRS/ WIFI Connectivity

PurchasePrice

$95

$150

Accessories

XENTA Swivel Plate

XENTA Tilting Mount Stand

$150

$55

XENTISSIMO Standard Cradle

XENTISSIMO Spare Battery

$29

$25

$35

$39

$35

$45

$45 $35

EFTPOS Terminals

(Enter QTY of accessories)(Enter QTY of terminals)

YOMANI 3G Desktop Model (USB powered) with Ethernet Connectivity including 2m Ethernet Cable

YOMANI / XR Security Fixation Plate

YOMANI / XR Tilting Mount Stand

$10

$150

What % of your card transactions are

Monthly Rental

> $100k p.a < $100k p.a * *

Card $ turnover per year

All fees and charges are quoted as of 1st of January 2014, exclusive of GST and may be varied under the terms of the agreement.

*

Please select the type and quantity of terminals/accessories required. The monthly rental fee includes access, support and maintenance. Non-returned terminals are charged at replacement cost.

0.93%

0.93%

0.93%

(1.00%)

0.93%

$0.15

$0.34

$0.15

$0.00

Merchant Declaration (If a Company has two Directors, both must sign)

Full Name Director/Secretary/Proprietor (1)

Authorised Signature (1)

Driver's License or Passport Number

Date of Birth (dd/mm/yyyy) Home Phone No

Date signed (dd/mm/yyyy)

Residential Address

Street

Suburb

State Postcode

Authorised Signature (2)

Driver's License or Passport Number

Date of Birth (dd/mm/yyyy) Home Phone No

Date signed (dd/mm/yyyy)

Residential Address

Street

Suburb

State Postcode

Full Name Director/Secretary/Proprietor (2)

Authorised signatures: For companies >50M gross revenue signed by authorised representative as per delegated authority For companies <50M by two directors/secretary (Unless a sole director) For partnership or sole traders by proprietor.

1. I declare that I have accessed and read theEFTPOS Price Schedule and Merchant Service Agreement - General Terms ("Terms"). The Terms are available at www.tyro.com

2. I agree to be bound by the Terms and anyvariation of the Terms.

3. I agree that the information provided in this application is correct and authorise Tyro to exchange information about it and this application with any source, including a Credit Agency, Bank or Financial Institution.

4. I authorise each source to give Tyro any information about the applicant whichTyro requires for this application and I release Tyro and each source from liability for, and indemnifies Tyro and each source against, all claims and losses arising out of disclosures made in the course of suchinquiries.

5. I have read and understood the Privacy Statement in this form and I consent to the collection, use and disclosure of personal information and merchant information in accordance with the Privacy Statement. Where I have provided information about another individual, I declare that the individual has been made aware of that fact and the contents of the Privacy Statement.

Direct Debit Request - Settlement/Deposit Account

Set-Up Options

For avoidance of doubt, the signing of this agreement by the Merchant does not signify agreement by Tyro. This will be confirmed once the Merchant Application Form has been processed.

Privacy Statement - Individual and Merchant Information (Your right to privacy is important to us)

Tyro collects personal information about you so that we can provide you with the services you have requested or offer you other services, which may be relevant to your needs, or for both purposes. Personal information provided to Tyro may be shared with related companies where it will be kept strictly confidential and will only be disclosed on a need to know basis. Tyro will use and disclose personal information for the purpose for which the personal information was initially collected. Tyro's Privacy Policy can be viewed on its website www.tyro.com

By signing this document, I/We authorise TyroPayments Limited 49 103 575 042 (the Debit User) to debit/credit my/our account, detailed above, with fees, charges and any other amount due by the Merchant under this Agreement through the DirectDebit System. I/We must pay the Debit User when due under the arrangement between the Debit User and me/us. The purpose of these debits will relate to fees, chargebacks, corrections and negative settlements.I/We understand and acknowledge that the debit user may vary the amount or frequency of debits under this authority in accordance with any variation to the arrangement between the Debit User and me/us.

Tyro Payments Limited ABN 49 103 575 042

Name of Account Holder (1)

Authorised Signature (1)

Name of Account Holder (2)

Authorised Signature (2)

Bank Account Name

I/We have accessed, read and accepted the Direct Debit Request Terms and Conditions available on tyro.com (If joint account, all signatures may be required).

BSB Number Account Number

Date signed (dd/mm/yyyy)Date signed (dd/mm/yyyy)

(Tick appropriate box)

Additional set-up options under the same ABN in the same location/outlet

I have different business lines with different dedicated terminals and different trading names on the EFTPOS receipts

Provide the names to appear on the receipts and a Direct Debit Request for each additional bank account.

I have different business lines sharing the same terminal/password, generating differentiated EFTPOS receipts under the same merchant group name indicated here:

Additional optional text to appear on bank statements

Debit fees from a separate bank account (Attach separate Direct Debit Request. Go to tyro.com>documents)

(Additional optional text)

Fully taxed Exempt/Not registeredConfirm your GST registration for DCC purposes:Enable Dynamic Currency Conversion (DCC)

Consent to recipient created invoices: I agree to Tyro generating Recipient Created Tax Invoices (RCTI) for my DCC service

POS software: Version:

Additional EFTPOS facilities on the same ABN. (Additional Site Request. Go to tyro.com>documents)

Enable integration with your POS software (Check the certification status. Go to tyro.com>integration)

FOR INTERNAL USE

SCANNED

SAVED

SF ENTRY

BO ENTRYS.R.:

DATE:

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