Credit Card Application the Web by iio35749

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									                                                                                                                  Business Services
                                                                                                            The University of Montana
                                                                                                       Missoula, Montana 59812-1254




MERCHANT ACCOUNT / CREDIT CARD MACHINE REQUEST FORM
To request a Merchant Account for either a web application or phone terminal processing Credit Card payments
and for credit card machine approval, provide the information below to Business Services.

Department:                                                                 Shipping Information (for terminal and supplies)
Contact:                                                                    Address:
Address:



Phone:                                   Fax:                                E-Mail:

Secondary Contact Information
Name:
Phone:                        Fax:                                           E-Mail:


Credit Cards which will be accepted:
   Visa/MasterCard

Merchant Number (to be completed by Business Services)



Type of processing:
    Face to Face - swipe card on terminal (with this option a terminal must be purchased)
    Mail order/phone order-card not present (with this option a terminal must be purchased)
    Web payments
    Fax Orders

Platform to be used:
     Phone Line with Terminal
     World Wide Web


Applicant information (College/Department):
Purpose of account:
                         i.e.: ticket sales, applications, conference or seminar registrations, etc.
Web Site Address:

Average transaction amount:                                                  Yearly Volume:
                                                    (estimate)                                          (estimate)
          Average transaction amount is an estimate of the average credit card sale amount you expect to process


Dates of usage:                           Approximate Starting Date
                                          Approximate Ending Date:
                 Dates of usage are approximate dates of when the registrations/sales/etc will be processed.

Index Code:

Clearing Account:                           50287 Credit Card Clearing Quick Reference
F1204
                                                                                               Business Services
                                                                                         The University of Montana
                                                                                    Missoula, Montana 59812-1254




The PCI DSS, a set of comprehensive requirements for enhancing payment account data security, was
developed by the founding payment brands of the PCI Security Standards Council, including American Express,
Discover Financial Services, JCB International, MasterCard Worldwide and Visa Inc. Inc. International, to help
facilitate the broad adoption of consistent data security measures on a global basis.

The PCI DSS is a multifaceted security standard that includes requirements for security management, policies,
procedures, network architecture, software design and other critical protective measures. This comprehensive
standard is intended to help organizations proactively protect customer account data.

https://www.pcisecuritystandards.org/security_standards/pci_dss.shtml



The following individuals have my authorization to operate one or more University of Montana Credit Card
Processing Terminals. These staff members understand the responsibilities of operating an Electronic Data
Capture Terminal and are prepared to comply with the guidelines and procedures for University of Montana credit
card processing. The undersigned has read and understands the credit card processing [policy].


                        Signatures                              Print Name                      Date

OPERATOR

OPERATOR

OPERATOR

OPERATOR

OPERATOR

OPERATOR

OPERATOR




___________________________________________________                     _________________________
Department Director, Dean, Chair Signature                              Date




F1204

								
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