2009 Retail Branch Program Order Form

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2009 Retail Branch Program Order Form Enrollment ICBA Promotion August 1st - September 30, 2009 Information Billing & Shipping Information Please photocopy and fill out a separate form for each promotion period in which you wish to participate. Submit forms to Visa Fulfillment. Bill To Ship To Marketing Contact Name Shipping Contact Name Title Title Issuer/Organization Name Issuer/Organization Name Address Address (no P.O. Boxes please) City/State/Zip City/State/Zip Phone/Fax Phone/Fax Email Address** Email Address** Billable BID† (required) Billable BID† Authorized Signature/Date Ship all materials to the shipping address above. Do you want your materials collated into individual packages? Yes (Additional timing and collation charges per branch will apply. Contact Visa Fulfillment for a quote and delivery schedule.) No, I will collate and distribute materials myself. Ship materials to multiple addresses. • Attach a separate list of shipping addresses. • Indicate which materials to ship to each location. Prices do not include tax, shipping, handling, customization, collation and/or storage costs, which will be added to your total cost, if applicable. Note: All orders are final. No exchanges, credits or refunds. * Please attach a separate sheet listing the name and address of all participating branches and participating agent banks (if applicable). ** Will only be used for promotion-related communication. † Material costs will be posted to your institution's Visa settlement account approximately two months after your delivery date. Please provide the following information: Number of participating retail branches or locations* Total number of participating employees ICBA members MUST fax this form to 320-251-1406 or email it to visa.fulfillment@merrillcorp.com in order to receive the special ICBA member 10% discount.

2009 Retail Branch Program Individual Materials Order Form Most of these items are included in the promotion packages. However, you may wish to order additional materials, based on your needs. Take 10% off of the Unit Price as an ICBA member Visa® Consumer Card Materials V9016502-1108-CA Consumer Card Small Poster $2.00 V9016502-1108-CH Consumer Card Large Poster $4.50 V9016502-1108-CB Consumer Card Tent Card $1.50 V9016502-1108-CF Consumer Credit Card Customer Brochures (25 per pack) $3.00 V9016502-1108-CG Consumer Check Card Customer Brochures (25 per pack) $3.00 Visa Business Card Materials V9016502-1108-CU Business Card Small Poster $2.00 V9016502-1108-CY Business Card Large Poster $4.50 V9016502-1108-CV Business Card Tent Card $1.50 V9016502-1108-CW Business Credit Card Customer Brochures (25 per pack) $3.00 V9016502-1108-CX Business Check Card Customer Brochures (25 per pack) $3.00 Visa Prepaid Card Materials (Buxx®, Gift, TravelMoney®) V9016502-1108-CA Consumer Card Small Poster $2.00 V9016502-1108-CH Consumer Card Large Poster $4.50 V9016502-1108-CB Consumer Card Tent Card $1.50 V9016502-1108-CI Visa Buxx Card Customer Brochures (25 per pack) $3.00 V9016502-1108-CJ Visa Gift Card Customer Brochures (25 per pack) $3.00 V9016502-1108-CK Visa TravelMoney Card Customer Brochures (25 per pack) $3.00 Customer Promotion Materials V9016502-1108-CP Customer Instant Win Game Cards (15 per pack) $10.50 V9016502-1108-CQ Customer Promotion Rules Pad (25 sheets per pad) FREE Item Number Description Unit Price Total Qty. Cost ICBA members MUST fax this form to 320-251-1406 or email it to visa.fulfillment@merrillcorp.com in order to receive the special ICBA member 10% discount.

© 2009 Visa. All Rights Reserved. Employee Incentive Materials V9016502-1108-RK Retail Manager's Kit (Manager's Guide and Employee Prize Pack) $19.50 V9016502-1108-BF Retail Manager's Guide $3.00 V9016502-1108-BG Employee Prize Pack (15 game cards with at least 5 prizes per pack) $16.50 V9016502-1108-BI Employee Promotion Rules (available online us.visaonline.com/adventure2) FREE Employee Training Materials V9016502-1108-BJ Consumer Credit Card Online Training and Game $8.00 V9016502-1108-BK Consumer Check Card Online Training and Game $8.00 V9016502-1108-BL Business Credit Card Online Training and Game $8.00 V9016502-1108-BM Business Check Card Online Training and Game $8.00 V9016502-1108-BN Visa Buxx Card Online Training and Game $8.00 V9016502-1108-BO Visa Gift Card Online Training and Game $8.00 V9016502-1108-BP Visa TravelMoney Card Online Training and Game $8.00 V9016502-1108-SG Visa Signature Card Online Training and Game $8.00 TOTAL Item Number Description Unit Price Total Qty. Cos t Comprehensive Discount Pricing Shown Below in Red. ICBA members MUST fax this form to 320-251-1406 or email it to visa.fulfillment@merrillcorp.com in order to receive the special ICBA member 10% discount. Take 10% off of the Unit Price as an ICBA Member Comprehensive Discount Pricing Shown Below in Red

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