Wichita State University Credit Card Acceptance Form 1. Describe ...

Wichita State University Credit Card Acceptance Form
1. Describe the goods, services, and/or events for which you will receive payments. Please be
specific.
2. Is this an existing or new source of revenue?
3. Are you currently conducting business with credit cards? If so, please explain. (Ex: mail, phone,
online, In person)
4. Will you need a printer for receipts?
5. What is the funding where funds will be deposited (FOAPAL)?
6. Please explain why your department wants to accept credit card payments:
7. Describe the frequency of credit card payments. Is this a one-time event? Are payments for
seasonal or year-round activity? Please provide timeframes.
8. What other methods of payment do you anticipate accepting for this specific purpose? Credit
Cards or Cash/paper Checks.
9. How do you plan to process these payments? In-person (Card present), Online, Phone/Fax (For
security reasons, faxes MUST be secured.)
10. Indicate the estimated annual dollar volume and number of transactions for each applicable
credit card acceptance process:
In Person $ # of Transactions
Internet $ # of Transactions
Phone/Fax Order $ # of Transactions
11. Please identify any alternate representatives that will be involved in processing credit card
payments. Include first and last name, Job Title, myWSU ID, Phone Number and describe duties.
Web Based Storefront:
12. If you are planning to accept credit card payments via the Internet, do you already have an
established website where you would like a “pay” button? If so, please provide the URL:
13. If you are requesting a Marketplace website( a Store in the WSU Mall,
https://wsuwebcheck.wichita.edu/C21797_ustores/web/index.jsp ), please answer the
following:
a. Storefront Name:

. Primary Fulfiller (Contact who can answer questions and resolve credit card
discrepancies)
c. Backup Fulfiller:
d. Store Contact:
e. What information do you need to collect from each customer? (Name, Address, and
Email are collected by default)
f. Do you have a description and images for your product(s)?
g. Will your product(s) be price+ tax, tax inclusive or tax exempt? If yes, please describe.
h. Will you be selling products to another state agency or a tax exempt organization? If
yes, do you have their sales tax exempt certificate on file?
14. What is your refund policy?
15. Will you need to ship products? If yes, please specify.
16. Will any other departments, software packages, or outside vendors be involved in the processing
of credit card payments? If so, please identify all parties and describe their roles and
responsibilities.
By signing this form, the department representative acknowledges that he/she has read and fully
understands the policies and procedures of accepting credit card payments.
By signing this form, the department head approves of the business case presented for the
department to become a CME (Cashier Merchant Edition) or Marketplace department, has read
and fully understands the policies and procedures of accepting credit card payments and has
agreed to the designated department representative above as well as approves the 5% credit card
fees.
Date:
Department Head Signature:
Printed Name:
Department Representative Signature:
Printed Name: