Merchant Card Service Level Agreement
Unit Name:
Merchant Number(s):
Contact Name (Print):
email Address:
Fax Number:
Term of Agreement
Unit Number:
Phone Number:
January 1,
to December 31,
1. This unit uses the following credit card method(s)/Payment Gateway (e.g., ePayment with a
Hypercom device):
Note: A current list of the pre-authorized methods can be found on the List of Authorized ePayment Services. If manual imprint machines are used, please indicate reason.
2. Reconciliations should be performed using the appropriate separation of duties.
 Reconciliations of the electronic payments with funds deposited by the merchant service
provider into University bank accounts and into the Shared Financial System ledger are
performed by Accounting Services. Any variances are researched between Accounting Services
and the merchant contact:
(enter individual’s name).
 Reconciliations of the Shared Financial System (SFS) recorded credit card transactions to the
merchant software credit card transactions are performed by:
(enter individual’s
name).
3. Each campus merchant site must provide a current, contact person to the Controller’s Office. The
contact person’s name and phone number for this unit is:
(enter individual’s name and
phone number).
4. Indicate how the unit are accepting credit cards:
Method
% of Transactions
UWM authorized web application(s) - online
Phone
Mail
In-Person (walk-in)
Other (requires pre-approval by the Controller)
Total
100%
Description of “Other” method.
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5. Units are not permitted to transmit, process, or store credit card information on any of the
following devices noted below. Exceptions require prior written approval by the Controller’s
Office. Request for approval of an exception by the Controller’s Office is signified by checking
applicable boxes below:
UWM Systems, applications, or servers
Fax Machines and photo copiers with memory
Email
Removable Electronic Storage: Please select appropriate boxes.
USB Memory Stick
Hard Drive
Zip Disk
Other
Other
If any of the above boxes are selected, contact the Controller’s Office to obtain written
approval.
Controller’s Approval
6. All but the last four digits of the credit card number must be deleted (blackout is not a sufficient
method of deletion) for long-term storage of the transaction. Is your area recording and storing
the entire number in either paper or electronic form?
No
Yes (please indicate why
)
7. Documents containing credit card data are being stored in these locations.
Paper records are stored (Bldg, Room):
All electronic credit card information are stored (list device and location):
Do not store any records with credit card data
8. Our purchasing receipts show:
Do not print/send receipts
Last four digits of the credit card number
More than the last four digits of the credit card number (why and list compensating
controls
)
Expiration date (why and list compensating controls
)
9. Refunds are credited to:
Do not process refunds
Same credit card as the original purchase
Different credit card than the original purchase (requires pre-approval by the Controller)
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10. The unit electronically stores credit card numbers on UWM equipment. Therefore, the unit needs
to have network scan performed.
No
Yes (Please indicated IP Addresses to be scanned
)
11. The Controller’s Office has examined compliance with applicable standards and the existence and
reliability of compensating controls and has approved the following exceptions:
Authorized Signatures
I affirm that I have read and understand the UWM Merchant Card Administration Procedure
and the related Credit Card Acceptance Policies, Procedures and Standards as they pertain to
my credit card environment. I understand that if I violate confidentiality or PCI standards, I may
be subject to University disciplinary actions, and/or criminal prosecution and my unit may lose
the privilege to serve as a credit card merchant.
Contact Name (Print):
Contact Signature
Date:
UBR Name (Print):
UBR Signature
Date:
Controller’s Name (Print):
Controller’s Signature
Date:
Return completed form to the Controller’s Office in Engelmann Hall
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