Temporary ONLINE Merchant Site Request Form

Date:
After completing this form, please mail it to Warriner Hall 205 or fax it to 989-774-1069.
(IF YOU HAVEN'T DONE SO, YOU NEED TO SUBMIT AN IT DEVELOPMENT REQUEST)

Requestors Name

Title/Position

Department

Email Address @cmich.edu

Phone Number Fax Number


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 Overall Sales

Average Transaction Amount

Sales Cost Center
GL
Merchant Discount & Settlement Fees Cost Center
GL
Monthly Fee Cost Center
GL
Transaction Fee Cost Center
GL

Please list the individuals that will need admin access to the credit card acceptance website and select the type of access they will need. (Check all that apply.)

Name Global ID
Reporting
Process Refunds

I agree that by submitting this form, I am requesting to process credit cards using a CMU Merchant Site. I agree to follow all policies and procedures set by Payroll/Travel Services, the credit card companies and CMU's contracted service providers.

Signature ____________________________________ Date ________________

Be sure to submit an IT Development Request. For assistance please contact (989)774-3797.