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Take A Step Towards PCI Compliance
Please complete the below form to begin the process of ensuring your store is PCI compliant.
Your Name
(Required)
Your Email
(Required)
Your Phone Number
(Required)
Co-op Name
(Required)
Address Line 1
(Required)
Address Line 2
City
(Required)
State
(Required)
Zip Code
(Required)
Card acceptance processes
Card in Hand/in-person
Ecommerce
Mail Order
Telephone Order
Select all that apply to your Co-op
During the past 12 months did your co-op process
more than 6 million Visa transactions?
more than 6 million MasterCard transactions?
more than 6 million Discover transactions
more than 2.5 million American Express transactions?
Who is your payment processor?
Fiserv/First Data
FIS/Worldpay/Vantiv
Gravity
Precision Payments
Ignite Payments
Other
Processor name:
Card in Hand
Dipped for chip cards
Swiped
Manually entered into device
Touched
Mobile
PIN Transaction Security (PTS) devices are used by a merchant at the point-of-interaction for capturing payment card data and validating approval of its use for a transaction Are payment cards (mark all that apply)
Brand and model of PTS device
Verifone MX915
Ingenico Lane/7000
Equinox
Clover (First Data/Fiserv)
Other
Model
Brand & Model
Does the device provide Point to Point Encryption (P2PE)? You may need to consult with your POS provider.
Yes
No
Have you received a P2PE Implementation Manual?
Yes
No
Does the device provide End to End Encryption (E2EE)? You may need to consult with your POS provider.
Yes
No
Company you purchase devices from
NCBP
NCR
ECRS
STCR
Other
Name of Company
Do you have a Point of Sale (POS) that is used as a cash register?
Yes
No
What POS software is used?
CoPOSCounterpoint
ECRS catapult
EZSCAN
IS4C
IS4C/CORE
IT Retail
LOC SMS
NCR
Nextor
Other
Other POS software provider
Is the following cardholder data: Primary Account Number(PAN), expiration date, CVV number manually entered?
Yes, into PTS device
Yes into virtual terminal browser window with keyboard on computer?
No, Not manually entered
Ecommerce: Does the website accept credit cards?
Yes
No
What company provides the shopping cart or payment page on website?
The Co-op
StoreByWeb ECRS CATAPULT WebCart
FreShop
Mercato
Other
Other Company
What is the name of the Payment Gateway (company that processes the credit card on the website.)
First Data/Fiserv/Payeezy
Stripe
Acculynk
Plug’npay
Level UP
Worldpay/FIS/Vantiv
PayPal
Zift
First Atlantic Commerce
Ipay88
MCB
Authorize.net
CyberSource
Square
NCR Connected Payments
Other
Other payment gateway
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