Merchant Request Form | Financial Services

General Information

Enter the department name*

Enter your name*

First

Last

Enter your email address*

What type of request is this?*

New Merchant Request

The questions below pertain to new merchant requests.

Describe your department's need for accepting credit cards*

How are you planning on accepting payment cards (e.g. payment card terminal, website, payment gateway, etc.)?*

Does this service relate to a contract with one or more third party service providers? A service provider is any external supplier that will help support your business process.*

Yes
No

Third Party Service Provider Information

List the third party service providers and describe what services they will provide.*

Service Provider Name	Description of Service(s) Provide

Attach all documents (e.g. contracts, statements of work, etc.) that you have from the third party service providers*

Drop files here or

Merchant Points of Contact

Enter the contact information for the department head for this merchant request.*

The department head will be contacted to get approval for this request and confirm that the merchant staff will maintain operations that follow the Payment Card Acceptance Administrative Policy and related procedures.

Name	Title	Phone Number	Email

Provide all points of contact for the new merchant.*

These points of contact will be used to answer follow-up questions, work on providing credit card security (PCI) compliance documentation, respond to charge back / dispute requests, etc.

Name	Title	Phone Number	Email

Anticipated Transaction Volumes

For each question in this section, please use your best judgement to estimate the amount and percentages of transactions that will occur in your merchant account. If this is a new service, please estimate these values as best as possible.

What is the anticipated yearly dollar volume?*

This should be the AMOUNT of all transactions that you expect to process in a calendar year.

Please enter a number greater than or equal to 0.

What is the anticipated annual transaction volume?*

This should be the COUNT of all transactions that you expect to process in a calendar year.

Please enter a number greater than or equal to 0.

What is the expected average transaction amount?*

Use the information provided in the prior to questions to determine this answer. Use the result to confirm if the other answers appear appropriate or not.

Please enter a number greater than or equal to 0.

Merchant Configuration Information

Enter the merchant name.*

The merchant name is limited to 24 characters and must include “WFU”. This will appear on your customer’s credit card statement.

Enter the Workday Cost Center or other special Worktags that should be used to allocate merchant fees.*

Do you wish to accept American Express card transactions?*

All merchants are automatically set up to accept MasterCard, Visa and Discover card transactions.

Yes
No

Do you wish to accept PIN-based debit transactions?*

Yes
No

Terminate an Existing Merchant

The questions below pertain to terminating an existing merchant.

Enter the merchant name*

Enter the merchant ID (MID)*

Enter the date that the merchant account should be closed with the bank.*

Have all third party service providers been communicated to and services terminated?*

Yes
No

Has all equipment been returned to Financial Services yet?*

All equipment used in the processing of card payments MUST be returned to Financial Services for proper disposal.

Yes
No

Merchant Change Request

The questions below pertain to updating existing merchant accounts. Some questions are not required; only answer these if you are wanting to change your existing configuration or process.

Enter the existing merchant name*

Enter the existing merchant ID (MID)*

Describe what needs to be changed on your merchant account?*

Include any business process changes or engagements with new third party service providers.

Provide a current list of points of contact for the existing merchant.

These points of contact will be used to answer follow-up questions, work on providing credit card security (PCI) compliance documentation, respond to charge back / dispute requests, etc.

Name	Title	Phone Number	Email

Update the merchant name.

The merchant name is limited to 24 characters and must include “WFU”. This will appear on your customer’s credit card statement.

Enter the new Workday Cost Center or other special Worktags that should be used to allocate merchant fees.

Do you wish to change your acceptance of American Express card transactions?

Start accepting
Stop accepting

Do you wish to change your acceptance of PIN-based debit transactions?

Start accepting
Stop accepting

Email

This field is for validation purposes and should be left unchanged.

Financial Services

General Information

New Merchant Request

Third Party Service Provider Information

Merchant Points of Contact

Anticipated Transaction Volumes

Merchant Configuration Information

Terminate an Existing Merchant

Merchant Change Request

Support Wake Forest

Call to Conversation