Merchant Card Processing Request Form

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1 Merchant Card Processing Request Form This form must be filled out and approved before accepting credit card payments at any new location or via any website. of Application: Type of Request: e-commerce Terminal 1. Bldg/ Street Phone # City Fax # Zip Mail 2. Business Contact Phone # 3. Account Number to charge for monthly rental and discount fees Fund Project Activity Account (Usually 78680) 4. information (if different than above): Bldg/ Street Phone # City Fax # Zip Mail 5. A location name must begin with with NU <space> and be followed by no more than 20 additional characters, including spaces, for a maximum 23 characters total. The location name will print as the description on the customer credit card statement. Choose a name that your customer will recognize. Example location name: NU Store Requested location name: NU 6. Attach documentation signed by the Director of the and the Business of the school: Project description: business purpose, services and products being sold, project plan including timeline Estimated annual transaction volume and average dollar amount per transaction e-commerce Application Addendum (for e-commerce requests only) Procedures for collecting, recording, and reconciling sales and refunds (including cash, checks, and charges). Include specific staff and/or positions responsible for process steps ensuring duty segregation, and independent review and reconciliation of transaction data. In signing, the authorizing parties confirm that: All impacted personnel have read the NU Merchant Card Processing Policy and agree to adhere to it. The department agrees to participate in the Treasury Operations administered PCI compliance programming including completing annual questionnaires and attending security training and informational meetings. Requested by: Printed Title Signature Director or Dean Approval: Printed Title Signature Please return to the Treasury OPS e-commerce, 619 Clark St., Evanston Campus MC 1130 MERCHANTS CANNOT ACCEPT CHARGES UNTIL THEY HAVE APPROVAL FROM TREASURY OPS E-COMMERCE DEPT.

2 e-commerce Application Addendum This form must be attached to the Merchant Card Processing Request Form. The following additional information must be provided when requesting to process credit cards via a web site. A. Proposed URL: B. Technical Contact (Usually differs from the Business Contact on the main application form) Phone # C. Select type of e-commerce system proposed Application Service Provider (The system is hosted and maintained entirely by an offsite provider) Provider name: -hosted, purchased application software, payment processing outsourced of software vendor: of software application: of payment processor (i.e. Payflow Link): -hosted, custom application software, Payflow Link for payment processing Describe: Other, describe: D. Are all vendors, service providers, and hosts certified PCI compliant? (Attach explanation on back or separate sheet) E. Are all vendors and service providers PA-DSS compliant and/or is the system on the PABP list? (Attach explanation on back or separate sheet) F. Do all contracts contain security acknowledgements pursuant to PCI DSS requirement 12.8? (Attach explanation on back or separate sheet) G. Will department personnel view or enter cardholder data (i.e. entering purchases on behalf of customers, processing refunds based on card number, or generating reports that include card numbers)? If yes, have these employees had background checks performed by Human Resources? H. Will cardholder data be stored, processed or transmitted on equipment connected to the NU network? I. Attach additional technical documentation: Software vendor and/or hosting provider contract(s) Network diagram depicting all on-campus computing assets that will be connected to the proposed system Appropriate PCI SAQ (Self-Assessment Questionnaire) downloaded from SAQ Form SAQ A SAQ B SAQ C SAQ D Please return to the Treasury OPS e-commerce, 619 Clark St., Evanston Campus MC 1130 MERCHANTS CANNOT ACCEPT CHARGES UNTIL THEY HAVE APPROVAL FROM TREASURY OPS E-COMMERCE DEPT.

3 Merchant Card Request Administrative Record For Treasury Operations and e-commerce Operations Office Use Only LOCATION NAME DATE REGISTERED PAYPAL ID FDMS MERCHANT # LOCATION CODE AMEX MERCHANT # CARD PROCESSING TYPE e-commerce Terminal Other PCI QUESTIONAIRE TYPE SAQ A SAQ B SAQ C SAQ D PCI SCAN REQUIRED For e-commerce requests only: NUIT has reviewed the department s security policies, contracts, and e-commerce system environment and approves of the security measures in place. David Kovarik, Director Info & Systems Security/Compliance Nancy Pinchar Assistant Controller Richard Emrich Asst. Treasurer Martin Soler e-commerce Program

4 Merchant Onboarding Checklist Prior to the first card swipe or online transaction, the following must be completed: Requirement Provide names and addresses of all staff of the credit card operation (use the table on the following page) Add new merchant to TrustKeeper Portal and send notification to Complete enrollment questionnaire on TrustKeeper Portal Complete initial Self-Assessment Questionnaire on TrustKeeper Portal If applicable for e-commerce merchants, setup TrustKeeper and/or NUIT Vulnerability scan schedule Mandatory review of PCI-DSS Security Awareness training document Mandatory review of PCI Security Policy Responsible Party e-commerce Supervisor or e-commerce Analyst IT Staff with e- Commerce or NUIT Personnel All Staff from list below All Staff from list below Completed

5 Merchant Onboarding Checklist - Continued In the table below, please list the names and addresses of all departmental staff that will be part of the new merchant card operation. The list should include all staff that will be involved in the credit card operation regardless of status. Each staff member is required to: 1. Participate in an annual PCI-DSS Security Awareness Training 2. Review the PCI Security Policy 3. Attest after completing both items above using the instructions provided in item 1 Address Title/Role or Function

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