Fillable CCSU PCI Compliance Statement Form

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CCSU PCI Compliance Statement Form

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File type: PDF

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Central Connecticut State University
12/19/2016 Page 1 of 1
CCSU Payment Card Industry (PCI) Compliance Statement Form
Employee Name: ________________________________________________________
Department:____________________________________________________________
Terminal Location:_______________________________________________________
Supervisor’s Name:______________________________________________________
I acknowledge that in the course of my duties I may have access to personally identifiable information
and/or otherwise confidential data of customers of Central Connecticut State University through the
processing of credit or debit card transactions. I understand that I will utilize this data solely for the
purpose of transacting a credit or debit card payment. I will not retain this information personally or
share it with anyone not having access rights.
I certify that I have read this procedure. I understand that failure to follow the procedures described
therein, unauthorized disclosure of personally identifiable information, or any other abuse of my access
rights is illegal and may be grounds for discipline, termination, and criminal prosecution.
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CCSU PCI Compliance Statement Form

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Completed 23 February 2020

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