MERCHANT SERVICES ACCOUNT REQUEST/MAINTENANCE FORM … · New Merchant Application Form Page 2....

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New Merchant Application Form Page 1 MERCHANT SERVICES ACCOUNT REQUEST/MAINTENANCE FORM Saint Louis University New Merchant Existing Merchant, New Payment Process/Application Update Merchant Manager or Contact Information Close Merchant Account TRANSACTION DETAILS Anticipated Frequency of Card Activity: Projected Annual Sales ($): CUSTOMER RECEIPT DETAILS Business Name: Phone Number: Address: PROCESSING DEVICE Point Of Sale (POS) Terminal Terminals are provided through our Merchant bank. Anticipate 6-8 weeks for setup and delivery. See page 2 for pricing. # of Terminals Requested: UPay Site E-COMMERCE SLUCare Use Only Customer ID Number: Department Contact Name:

Transcript of MERCHANT SERVICES ACCOUNT REQUEST/MAINTENANCE FORM … · New Merchant Application Form Page 2....

Page 1: MERCHANT SERVICES ACCOUNT REQUEST/MAINTENANCE FORM … · New Merchant Application Form Page 2. PAYMENT APPLICATION Describe the type of business activity that requires merchant processing:

New Merchant Application Form Page 1 Page 1

MERCHANT SERVICES ACCOUNT REQUEST/MAINTENANCE FORM Saint Louis University

New Merchant

Existing Merchant, New Payment Process/Application

Update Merchant Manager or Contact Information

Close Merchant Account

TRANSACTION DETAILS

Anticipated Frequency of Card Activity:

Projected Annual Sales ($):

CUSTOMER RECEIPT DETAILS

Business Name:

Phone Number:

Address:

PROCESSING DEVICE

Point Of Sale (POS) Terminal

Terminals are provided through ourMerchant bank. Anticipate 6-8 weeks for setup and delivery. See page 2 for pricing. # of Terminals Requested:

UPay Site

E-COMMERCE

SLUCare Use Only

Customer ID Number:

Department Contact Name:

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Request New Terminal
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Request E-Commerce - SLU Marketplace Site
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Request U-Pay Site
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Request Third Party Vendor/Terminal Set-Up
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Wireless Point of Sale (POS) Terminal
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Wireless terminals transmit credit card data through a cellular network. Anticipate 6-8 weeks for setup and delivery. See page 2 for pricing.
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Third Party Terminal
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University preferred payment gateway for use with University Websites or Third Party Vendors
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E-Commerce Marketplace
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E-Commerce Third Party Vendor
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Contract with Vendor must include PCI language and must be approved by the PCI Compliance Committee. Name of Vendor: Does the vendor require a payment gateway? Is the vendor PCI compliant?
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Please copy/paste the link below into your browser to complete the form required for a SLU Marketplace Store Request.
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http://www.slu.edu/busfin/departments/treasury-and-investments/credit-cards-and-e-commerce/marketplace/marketplace-store-request
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Number of Terminals Requested:
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E-Commerce Site Requested:
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# of Terminals Requested:
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Third party terminals are required by a third party vendor. Name of Vendor: # of Terminals Requested:
Page 2: MERCHANT SERVICES ACCOUNT REQUEST/MAINTENANCE FORM … · New Merchant Application Form Page 2. PAYMENT APPLICATION Describe the type of business activity that requires merchant processing:

New Merchant Application Form Page 2

PAYMENT APPLICATION

Describe the type of businessactivity that requires merchantprocessing:

Select all methods in which creditcards will be processed:

Types of Credit Cards to Accept

Visa / MasterCard

Discover

American Express

Banner Fund & Account to be Billed:

Name of Fund/Account to be Billed:

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POS
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Wireless
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3rd Party Terminal
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E-Commerce 3rd Party
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E-Commerce Marketplace
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UPay Site
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Merchant Managers are responsible for the management of all aspects of merchant card processing related to their respective merchant. This includes compliance with all applicable policies and procedures as listed below, as well as oversight of all employees who handle or process credit card data. Managers are required to take the SLU PCI Compliance Training prior to the approval of any new merchant account or processing. This excludes those Merchant Managers who have already completed the training within the past year.
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Merchant Manager Name: Merchant Manager Office Address: Phone Number: E-Mail:
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List all individuals within your department, including student workers, that handle credit card data:
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Standard Pricing for Terminals: FD130 Terminal with PIN Pad $599.00 FD410 Wireless Terminal $766.00 Clover Flex Wireless Terminal $569.00 Standard Fees: Wireless Terminal Fee $15.00 per month Standard Terminal Fee $5.00 per month Marketplace Fee: 2.25% of monthly total revenue Processing Fees $.10 per transaction + M/C/Visa/Discover/AMEX Interchange/Assessment Fees 2% - 3% Please note that these prices are subject to change. For a more detailed breakdown of services and fees, please email [email protected]
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Training for PCI Compliance must be completed by all employees that accept or will accept credit cards. For any questions, please contact Katelyn Zobrist at 314-977-2221 or [email protected]
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APPROVALS Merchant Manager Date Department Head Date Dean/Vice President Date PCI Compliance Committee Date
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Fund:
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Account:
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MERCHANT AGREEMENT FORM - Orange Liberia

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