Appendix A

CHECK CASHING FEE SCHEDULE FEES CHARGED TO CASH A CHECK MAY VARY AMONG BUSINESSES. YOU MAY WISH TO COMPARE THESE CHARGES TO THOSE OF OTHER CHECK CASHERS AND FINANCIAL INSTITUTIONS IN CONSIDERING THE TOTAL COST OF YOUR TRANSACTION. COMPLETE FEE SCHEDULE OF _________________________________ Name of Licensee & License # Type of Check Percent Charged For Checks of $ to $ Percent Charged For Checks of $ to $ Percent Charged For Checks of $ to $ Payroll ____% ____% ____% Insurance ____% ____% ____% Government ____% ____% ____% Lottery ____% ____% ____% Personal ____% ____% ____% Money Orders ____% ____% ____% Other(Specify) ______ ____% ____% ____% ______ ____% ____% ____% EXAMPLE: FOR A CHECK OF $100.00 ON WHICH THE FEE CHARGED IS 1% YOUR TOTAL CHARGE IS $1.00 AND THE AMOUNT YOU RECEIVE BACK IS $99.00.