New Merchant Site Request Form

Central Michigan University




Cost Center GL IO (optional)
Merchant Discount & Settlement Fees
Monthly Fee
Transaction Fee
Online Payments

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.

Name Global ID Reporting
Yes or No
Process Refund
Yes or No
Terminal Payments

If accepting payments with a terminal, please fill out the following information.

Yes No

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.