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american express login by Crossofchanges

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									                  EMPLOYEE REQUEST FOR ONLINE PAYMENT CARD WEBISTE ACCESS


                        Date:                           12/10/08
                        Name:                           Adam Smith
                        Office or Department:           Finance
                        Email:                          smithab888@jmu.edu
                        Signature*:
                        Supervisor’s Name:
                        Supervisor’s Signature*:


    1. Action required? (choose only one)

             a.         Add access
                   or
             b.         Delete current access
                           Visa/MasterCard login ID: cl.smithab
                           Discover login ID: smithJMU
                           American Express login ID: smithab

    2. If you answered 1a, which online sites are needed? (check all that apply)

             a.    Visa/MasterCard (Merchant ID numbers in which access is needed: 825000000000,
                825011111111)
             b.    Discover (Merchant ID numbers in which access is needed: 601100000000000,
                601111111111111)
             c.    American Express (Merchant ID numbers in which access is needed: 4450000000,
                4450111111)

    3. Reason access is needed? Please delete all access for Adam as he is no longer in this department and
       should no longer have access to our merchant data.




Please submit this completed form to E-Commerce Coordinator in the University Business Office at MSC 3516.

                    University Business Office Use Only
                    ClientLine.net login ID:_____________________________ date:__________
                    AmericanExpress.com login ID:______________________ date:___________
                    Discover.com login ID:_____________________________ date:___________

* By signing this form and requesting access to view payment card transactions online, I acknowledge that I will come into contact
with sensitive data, including full payment card numbers, and I will not disclose this information to others. I will follow all Payment
Card Information Data Security Standards (PCI DSS) in regards to viewing and storing sensitive cardholder data.
Rev. 12/10/08

								
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