New Credit Card Acceptance : Student Business Services : Texas State University

Department Requesting Acceptance *

Account Contact Name *

Account Contact Email *

Account Contact Phone Number *

Technical Contact Name *

Technical Contact Email *

Technical Contact Phone Number *

Customer Service Phone Number *

Customer Service Email *

Fax Number

Brief Description of Need *

How do you interact with your current customers *

Categorize your product or service need *

If other, please describe product or service need

Do you already accept payments? *

If you already accept payments, indicate type of payment

Cash

Checks

Credit Cards

Existing source of customer transactions (check all that apply) *

In-person

Online via Internet

Phone

Mail

N/A

Provide any additional information about current payments

Indicate any existing credit card merchants numbers you have

In what manner would you like to accept credit card payments? (check all that apply) *

In-person

Online via Internet

Phone

Mail

Do you need to accept electronic checks or ACH payments? *

If you have an existing software system, please describe

Anticipated number of transactions per month *

Anticipated transaction dollar volume (amount) per month *

Average transaction amount *

Merchant name desired (20 characters and begin with TXST) *

0/20

SAP account number for merchant fees (CC, Fund, & GL) *

SAP Account number for e-commerce deposits (CC, Fund, & GL)

Infrastructure limitations (such as no phone lines or no internet)

Comments or additional information