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ALC \_[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.mark}\_\_

**CREDIT CARD ACQUIRING SERVICE**

**AGENCY PARTICIPATION AGREEMENT**

This Agency Participation Agreement ("APA") sets forth the terms and the
conditions of the \[AGENCY NAME\]'s ("Agency") participation in the
Financial Management Service ("FMS"), Credit Card/Debit Card Acquiring
Service.

The Agency agrees to follow the policies and procedures referenced
below:

a.  FMS Card Processing Rules and Regulations; and

b.  The Treasury Financial Manual sections related to credit/debit card
    acquiring processing.

This APA shall supersede all previous Plastic Card Network APA's (i.e.,
Internet, Intergovernmental, etc.) between the Agency and FMS, and/or
the Agency, FMS, and Financial Agent.

**ACCEPTANCE OF TERMS OF AGENCY PARTICIPATION AGREEMENT**

In witness whereof the following parties have executed this Agreement on
this \[DAY\] day of \[MONTH\], 20\[YEAR\].

By affixing their signatures, the parties certify that they are
authorized to enter into this Agreement and bind their respective
organizations to the provisions of this Agreement.

+---------------------------------+------------------------------------+
| \_\_\_\_\_\_                    | **Financial Management Service**   |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | Kristine S. Conrath\               |
|                                 | Director, Revenue Collection       |
| **Agency Name**                 | Group\                             |
|                                 | (202) 874-6430                     |
| \_\_\_\_\_\_                    |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\_\_\_                 |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                 | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| Agency Official                 |                                    |
|                                 | Signature                          |
| \_\_\_\_\_\_                    |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ | \_\_\_\_\_\_\_\_\_                 |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                 | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| Title                           |                                    |
|                                 | Date                               |
| \_\_\_\_\_\_                    |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                    |
|                                 |                                    |
| Telephone Number                |                                    |
|                                 |                                    |
| \_\_\_\_\_\_                    |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                    |
|                                 |                                    |
| Signature                       |                                    |
|                                 |                                    |
| \_\_\_\_\_\_                    |                                    |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                                    |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                    |
|                                 |                                    |
| Date                            |                                    |
+---------------------------------+------------------------------------+