Oakland University Merchant #
Credit Card Merchant ID Request Routing#
(Enter data below labels, please) DDA#
Department (Merchant) Name: Department Address:
Contact Person: Phone: E-mail: Fax:
Purpose: Please describe the goods and/or services to be paid for by credit/debit card.
Account Name To Be Displayed On Customer’s Receipt: COLLECTION METHODS: CHECK ALL THAT APPLY :
Card Terminal Cash Register PC Based Telephone Internet Fax Mail Other
OU Address to Print on Customer Receipt: Card Terminal - Stand alone device to process card transaction.
Cash Register - Unit that tracks cash and processes card transactions.
120 North Foundation Hall (Required) PC Based- Software enabling computer to track cash and process card transactions.
Indicate physical locations if point of sale machines are being used. If Internet:
URL for website : IP Address:
CREDIT CARD PROCESSING
(Check which method(s) you would like to use to accept credit cards. Default = Terminal) Gateway: Email account for credit card confirmations:
Credit Card Terminal/Printer PC Software Other
(Call Student Business Services at 370-2288 for info on PC or Other methods.)
CREDIT CARD TERMINAL OPTIONS Software (if applicable, attach a flow chart of your credit card process):
# Terminals @ $351 each: # Printers @ $280 each: Outside Line Access:
(minimum 1) (7) on main campus How is Sensitive Cardholder Data Protected? (Attach add'l explanation if needed)
1 1 7
INDICATE ACCOUNTING FOR CHARGEBACKS AND FEES: Is Sensitive Cardholder Data Processed on an OU machine?
Chargebacks (if not set fund/acct, explain) Processing Fees & Equipment Cost
Fund (5) Acct (4) Fund (5) Acct (4) Is Sensitive Cardholder Data Stored on an OU machine?
Is Sensitive Cardholder Data Transmitted on an OU machine or network?
Please indicate revenue amounts based on current sales if applicable.
Est. Annual Credit/Debit Volume: Anticipated Average Ticket: Vice President, Dean or Director Signature: Date:
Model/Serial #: Truncated?
SBS Use Only: Terminal 1: Printer1: Terminal 2: Printer 2: (Initial/Date)
Department has received/taken Name and Date Name and Date Name and Date
A Copy of Policy and Procedures:
Training Event Attended:
9a9bda83-d4a6-4a2a-9bf3-c43236b00bbd.xls Questions? Call Student Business Services at 248-370-2893 7/29/2012