Prior to beginning a Service Request via https://columbia.service-now.com/, use this Questionnaire & Checklist to ensure you have met all requirements and have completed any outside forms that you may be required to attach to your Service Request. Please refer to the online content found on the Finance Gateway for additional information.

If you will be working with any Third Party Service Providers (TPSP) that may or may not come in direct contact with cardholder data but could impact the security of your Cardholder Data Environment, provide the names here and provide a high level description of their role in your business process. Some examples include: payment gateway providers, web developers/hosting providers, software application providers, billing services.

How will you accept payment by credit card? Check all that will apply.

After you have determined with your Senior Business Officer, who will fulfill the following roles, list the individuals here (see Roles & Responsibilities):

Merchant Coordinator:

Authorized User(s):

Financial Coordinator:

Provide a brief description of what you will be collecting credit card payments for (e.g., subscriptions, medical services, application fees/deposits):

MERCHANT QUESTIONNAIRE & CHECKLIST

What chart string will you use to allocate your Merchant activity? This is where all Merchant activity will be posted to in ARC. Provide the natural account (44xxx) for revenue, related activity. All expenses will post to account 66122. (expense account must pass budget check).

IT Coordinator:

NEW MERCHANTS: Answer questions 1-5 below and complete the checklist on page 2.

EXISTING MERCHANTS: Proceed to page 3.

Account Department SegmentProject Initiative

If "In Person-Stand-alone Terminal" was selected, what type of Terminal do you plan on using?

Over the Phone or by Mail

Online via a Website

In Person/Stand-alone Terminal

Via a P2PE Solution

If "Via a P2PE Solution" was selected, provide the name of the P2PE Solution:

Business Unit

If "Online via a Website" was selected, provide the URL for your webpage and the IP address for where you're website will be hosted:

1.

2.

2a.

2b.

2c.

3.

4.

5.

URL IP Address

page 11.20.17

If you will be collecting credit card data online through your website and ARE using a Third Party Service Provider, have you confirmed which of the following approved Payment Gateways they can interface with and completed the respective New Merchant Request Form? (Select One)

If you are requesting a new ONLINE/WEBSITE OVER THE INTERNET (card-not-present) Merchant Account, have you requested a Test Payment Gateway account for the above applicable Gateway and used it to test integration with your website?

If you will be accepting credit cards in person using a stand-alone terminal, have you completed the ELAVON NEW MERCHANT REQUEST FORM? (you will need to attach this on the Service Now request)

If you will be collecting credit card data over the phone or through the mail, have you completed the ELAVON NEW MERCHANT REQUEST FORM ? (you will need to attach this on the Service Now request)

Have you received approval and a PO# from University Procurement Services for any Third Party Service Providers that could impact your Merchant environment? (you will need to provide this PO # on the Service Now request)

Do you have a documented Refund Policy? (and Privacy Policy for e-commerce?)

Have you documented departmental procedures for all Merchant related activities including but not limited to transaction processing and financial reconciliation (a copy will need to be provided with new Merchant request)?

Have all individuals that will have access to the Merchant environment completed the required PCI Basics training course and have you obtained copies of thier certificates?

Have you completed the MERCHANT SECURITY REVIEW FORM?All new Merchant environments and all changes to existing Merchant environments must be reviewed for compliance via this form. (you will need to attach this to the Service Now request)

All individuals who will be associated with this Merchant Account have reviewed and understand the Credit Card Acceptance and Processing Policy (including the related policies and appendices

relative to your specific processing type(s),

YES N/A

If you will be collecting credit card data through the mail, do you have a copy of your mail order form ready to provide with your request? (the form should NOT include a request for the cardholder CVV, CVC2, CAV2, CID)

If you will be collecting credit card data online through your website and are NOT using any Third Party Service Providers, have you completed the GLOBAL PAYMENTS NEW MERCHANT REQUEST FORM? (you will need to attach this to the Service Now request)

Converge Payment Gateway - ELAVON NEW MERCHANT REQUEST FORM

CyberSource - GLOBAL PAYMENTS NEW MERCHANT REQUEST FORM

NEW MERCHANTS continued...

page 21.20.17

EXISTING MERCHANTS

CLOSE EXISTING MERCHANT ACCOUNT

page 3

Select the appropropriate 'Processor specific Form' provided below and complete the sections relevant to your update request.

UPDATE MERCHANT ACCOUNT INFORMATION

Prior to beginning a Service Now request use the below checklist to confirm that you have completed the required form(s) indicated for each type of request.

PURCHASE OR RENT SWIPE TERMINALS

UPDATE CHARTSTRING FOR EXISTING MID

UPDATE YOUR MERCHANT ENVIRONMENT (including adding new services)

Have you completed the MERCHANT SECURITY REVIEW FORM?

No additional forms are required

No additional forms are required

No additional forms are required

ELAVON: REQUEST TO UPDATE EXISTING ACCOUNT FORM

REQUEST TO UPDATE GPN ACCOUNT FORMGLOBAL PAYMENTS:

Does your new chartstring have a confirmed budget setup on the expense side?

Have you disabled any processing equipment and/or websites that were associated with your Merchant Account?

Have you completed your final financial reconciliation?

1.20.17

ADD NEW USERS TO AN EXISTING MID

No additional forms are required

Find Instructions HERE

Find Instructions HERE

Find Instructions HERE

Find Instructions HERE

Find Instructions HERE