National Check Retrieval LLC

12123 Shelbyville Road

Suite 100-173

Louisville, KY 40243

Enrollment Form

This agreement is entered into on  (date) X______________ by and between

National Check Retrieval LLC

&

X________________________________

X ______________________________, hereafter referred to as Client to provide electronic redeposit of checks returned as insufficient or uncollected funds.

Client: X ________________________________________________________

Address:X ______________________________________________________

City:  X_________________State:X ___ Zip:X _____ County:  X__________

Phone: X ____________________ Fax: X_________________

E-mail : X _____________________________________

Officer’s Signature  X___________________________________________

Name Printed: X _______________________ Title X_________________

To provide ACH Services according to the Rules and Regulations, National Check Retrieval LLC and client agree as follow:

Client will post a sign at or near the checkout counter or notice in the check writer’s invoice, billing, receipt, rental agreement or any other document that the check writer will receive that notifies the check writer of the penalty associated with writing an NSF check and meets NACHA requirements.  National Check Retrieval LLC will provide a copy of such notice.

Client will sign an Authorization Agreement instructing the client’s bank to send NSF checks to National Check Retrieval LLC Processing Center via authorization instructions. National Check Retrieval LLC will give notice to client that the NSF check has been received and the collection process has started.

Each party represents, warrants, and mutually agrees that any information concerning the other party which comes into its possession shall be maintained as confidential and shall not be used or divulged to any other party except as necessary to permit the activities contemplated under the Agreement. Company may advise potential users of its service that Client has a relationship with Company.

Either party may terminate this Agreement at any time by written notice. Any termination will not affect Company’s or Client’s rights and obligations arising before the termination.

National Check Retrieval LLC charges no fees to Client for electronic check retrieval. Any check over $2500, over 180 days old, business checks, stop payments, closed accounts and checks that have been electronically presented three times will be sent to National Check Retrieval LLC collection agency for hard collection. The full amount of the check will be deposited into the Client’s account if and when collection is made on these checks.

If Client’s customer presents Client with cash, knowing a check has bounced, the client will NOT accept cash as a form of payment for the NSF check. Company cannot terminate our process once it has started.

This agreement makes up the entire agreement between Company and Client concerning ACH services.  If any provision of the Agreement is deemed unenforceable, the remaining provisions will still be enforceable.

Company Approval: Signature X____________________________

Name Printed X___________________ Title X_________________