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L Receipt Date: <br />ICN: <br />SECURE TRANSPORT COMMUNICATION PROFILE <br />❑ NEW ❑ CHANGE ❑ DELETE <br />Implementation of data transmission may require one to two weeks, depending on communications requirements, and to allow <br />sufficient time for testing. The information contained in this document will facilitate the set-up process. Please return the <br />completed form to your Bank of the West Cash Management contact or fax it to their attention at (323) 727-3229. If you have <br />any questions, please contact Bank of the West, Cash Management Customer Service at (800) 400-2781. <br />Company Name <br />Address <br />City, State, Zip <br />Telephone Number <br />Fax Number <br />Afterhours Transmission Support Number: <br />Afterhours Transmission Support Email: <br />Customer Contact <br />Contact E-Mail Address <br />Customer Technical Contact <br />Technical Contact E-Mail Address <br />THIRD PARTY VENDOR PROCESSING INFORMATION (if applicable) <br />Service Bureau/Vendor Name <br />Technical Contact Pager Number <br />Telephone Number Mobile Number <br />E-Mail Address <br />Alternate Contact Pager Number <br />Telephone Number Mobile Number <br />E-Mail Address <br />Afterhours Transmission Support Number: <br />Afterhours Transmission Support Email: <br />TYPE OF TRANSMISSION <br />1. Transmission Mode Requested: ❑ Transmit (Transmitting data to Bank of the West) <br />❑ Receive (Receiving data from Bank of the West) <br />2. Transmission capability is requested for the following Bank of the West services: <br />❑ Image Clearing Service (ICS) Financial Institution <br />❑ Account Recon <br />❑ Lockbox <br />❑ BAI <br />3. Frequency: ❑ Daily ❑ Weekly <br />❑ Other, please specify: <br />❑ ICS Commercial Customer <br />❑ ACH <br />❑ Sharedraft Image Archive Load File(s) <br />❑ Other (Please specify) <br />❑ Bi-weekly ❑ Semi-monthly ❑ Monthly <br />Secure Transport Transmission Form <br />Page 1 of 2 Revised: 02-2012 <br />