Note: Due to the rising cost of bank processing fees, we cannot accept less than the following minimum

Internet transactions … Minimum Sale Amount - $7.95 minimum sale per transaction

Name of person or company who referred

you to Hughes Billing Services :

Pam Winter

FTP Site Info

(Not required for Shopping Cart signups)

This information is used to access your existing Web Site in order for Hughes Billing to set up the

necessary files for Members Only Services.

YOUR Host Name (Example: WebSiteName.com) :

UserID (Provided by your web hosting company ) :

Password (Provided by your web hosting company ) :

Personal eMail Addresses

Note: Every consumer will automatically receive an eMail receipt of their purchase.

Main eMail address where we can contact you :

Please ALSO send a copy of the purchase receipt to

my eMail address at :

Send all Technical Support eMail to:

Personal Information

Please fill out this section.

Make my checks payable to :

Address #1 :

Address #2 :

City :

State :

Zip Code :

Country :

Telephone number where you can be reached :

Tax Information

This information is required for the U.S. forms 1098 and 1099 and strictly kept confidential.

Your Tax ID number, Social Security number, or

Social Insurance Number:

Membership Plan Information

(Not required for Shopping Cart signups)

What do you want to charge your customers (members) per month?

Multiple payment plans are acceptable.

2

Terms and Conditions

1. The credit card or electronic checking information will be collected on a secure eCommerce banking

server.

2. The credit card or electronic checking numbers will be verified and either automatically be accepted or

denied. An IP address will be collected from each applicant, recorded and used for any fraud

investigations.

3. If the credit card or electronic checking number is accepted, a username and password will be displayed

on the screen for the purchaser to gain access to your “Members Only” area.

4. A receipt will be eMailed to Hughes Billing, the purchaser, and also to a third party such as your own

customer service if required.

5. Hughes Billing will keep 14.5% of the total sale of each credit card transaction for the above mentioned

services.

6. Hughes Billing will keep 14.5% of the total sale plus an additional 40 Cents for each electronic check

transaction for the above mentioned services.

7. To protect our Merchant Account from chargebacks, Hughes Billing will hold back an additional 10% of

each sale for a period of 26 weeks. This policy is set in the event that your website and the services you

are selling would suddenly become unavailable to your online Customers, and Hughes Billing would be

obligated to refund any unused subscription charges to the Customer. Any monies held back and not

used for chargebacks are refunded in the current billing period, occurring 26 weeks after the billing period

when the monies were held back. The 26 week period will start on the day of the first sale from your web

site.

8. There will be an “Annual Fee” deducted from each payout in the amount of 1% of the total sales.

This minimal deduction is to help ease the burden of a large deduction up front that is normally charge by

other companies such as banks or other 3

rd

party processors. The total amount of the annual fee WILL

NOT exceed $375 per calendar year. The calendar year is from January 1

st

to December 31

st

.

9. Hughes Billing will issue a payment to the person listed on page 1 of this application on the 10

th

and 25

th

of each month along with a statement showing the total sales and amount due to you for the current pay

period.

Example: The money distributed on the 25

th

of each month will be for sales dated from the 1

st

to the 15

th

of

the current month.

10. If the amount owed to you on your pay period statement is less than $25.00 U.S. dollars, a payment will

not be issued to you for that pay period. The amount will be rolled over into the next pay period. For

example, if you only have $22.00 due to you, that balance will be rolled over into the next pay period.

11. All users of our shopping cart software agree to pay an additional $9.95 per month to pay for our server

space and per VISA/Mastercard regulations also agree to NOT LINK their shopping cart to any members

only subscription services. However, Members Only subscription services can be linked to the shopping

cart.

12. Hughes Billing reserves the right to change our rates at any time. Hughes Billing rates are dependant on

the rates charged to us by our banks. If our rates are increased, we reserve the right to increase your

rates.

13. Hughes Billing reserves the right to cancel an account at any time for any reason.

14. All Internet models on ANY website associated with this agreement and all persons listed on page 1 of

this agreement must be at least 18 years of age.

15.

By signing this agreement, you also agree to our Internet Terms and Conditions located at

http://www.hughesware.com/Billing/TermsAndConditions.htm .

By signing this agreement below and by filling out ALL of the information on page #1 of this agreement, you

give Hughes Billing Services permission and full access to modify the contents of your web server to handle

merchant banking transactions. All information is strictly held confidential.

Hughesware Computer Services

18640 Mack Avenue

P.O. Box 36967

Grosse Pointe Farms, MI 48236

Detroit Office Fax: 313-884-0124

On the web: http://www.HughesBilling.com

Sales eMail: Sales@Hughesware.com

Customer Service eMail: CustomerService@Hughesware.com

3

(Fill out this form if you want your funds directly deposited into a U.S. bank.)

To enroll in Direct Deposit into banks located in the United States of America for a fee of $9.00 per deposit,

simply print this form, fill it out, and fax it to Hughes Billing Services (Owned and operated in the United

States of America by Hughesware Computer Services, LLC). Fax No. 313-884-0124. Supply via fax a copy

of a voided check for the account listed below. This will ensure that you are paid correctly.

Note: Direct deposit funds will normally take 2 WORKING DAYS to appear in your bank account.

I hereby authorize HughesBilling.com (hereinafter “Company”) to deposit any amounts owed me by initiating

credit entries to my accounts at the financial institutions (hereinafter “Bank”) indicated on this form. Further,

I authorize the Bank to accept and to credit any credit entries indicated by Company to my accounts. In

the event that Company deposits funds erroneously into my account, I authorize Company to debit my

account for an amount not to exceed the original amount of the erroneous credit.

This authorization is to remain in full force and effect until Company and Bank have received written notice

from me of its termination in such time and in such manner as to afford Company and Bank reasonable

opportunity to act on it.

Name _________________________________ Social Security __________________________

Signature _________________________________________ Date _______________________

Company Name (If applicable) _____________________________________________________

1. Bank Name/City/State _________________________________________________________

Checking

Savings Account Number _____________________________

4

(Fill out this form if you want your funds directly deposited into your Pay Pal account)

To enroll in the “Free of Charge” direct deposit into your EXISTING Pay Pal Account, simply print this form,

fill it out, and fax it to Hughes Billing Services in the United States of America. (Fax No. 313-884-0124). Or

fill out this form electronically and eMail it toAccounting@Hughesware.com

.

I hereby authorize Hughes Billing Services (hereinafter “Company”) to deposit any amounts owed me by

initiating credit entries to my valid eMail account at Pay Pal indicated on this form. In the event that

Company deposits funds erroneously into my account, I authorize Company to debit my account for an

amount not to exceed the original amount of the erroneous credit.

The “Free of Charge” policy means Company will deposit the funds free of charge into my valid Pay Pal

eMail Address. I (“Your Name” as listed below) may be responsible to pay fees to Pay Pal in order to

receive these funds from my Pay Pal account. I (“Your Name” as listed below) will not hold Company

responsible to pay any fees whatsoever to anyone for my collection of these funds deposited by Company

into the below mentioned Valid Pay Pal eMail Address.

Your Name:

Web Site that Hughes Billing is providing Services for:

Valid Pay Pal eMail Address:

Social Security or Tax ID Number:

Signature:

Todays Date: