New Merchant Site Request Form
Central Michigan University
Email Address: @cmich.edu
What are you accepting payment for?
When do you want to start accepting online credit card payments?
How long do you want to accept credit card payments? (# of weeks/months)
Estimated Monthly Sales:
Average Transaction Amount/Ticket Size:
FUNDING AND FEES
IF accepting payment online,
please fill out the following information and
make sure to submit an IT Development Request.
Please list the individuals that will need admin access to the credit card acceptance website and select the type of access they will need.
If accepting payments with a terminal,
please fill out the following information.
Requested Site Name (24 Characters Max) This is what will show up on the credit cardholder statement.
Correspondence should go to the attention of:
Along with Discover, MasterCard, and Visa, would you like to accept American Express?
I agree that by submitting this form, I am requesting to process credit cards using a CMU Merchant Site. I understand that credit card information is sensitive data and should be stored in a secure environment. I agree to follow all policies and procedures set by Payroll/Travel Services, the credit card companies and CMU's contracted service providers.
Requestors name used as digital signature
Signature__________________________________________________(Signature is only required if not digitally submitting)
If you have trouble submitting this form please print, sign, and date it then send it to:
Warriner Hall 205 or fax it to 989-774-1069.