Credit Card Payment Option Request Form
Department Name:
Department Contact:
Business Purpose:
Is this business purpose new? Yes No
If not, what is your current process?
Is this a one-time event? Yes No
Request need by date:
Anticipated annual volume of transactions: # $
Who will be your customers? Students Employees Public
How will cards be accepted? Card Present e-Commerce Phone/mail order
Payment Options Requested:
1) CashNet e-commerce site
2) EMV/swipe credit card terminal
3) Mobile credit card terminal
Revenue Account line:
Department credit card fees charged to:
(Fees are approx. 3% of transaction amount)
My approval below indicates that I have reviewed the Gettysburg College credit card procedures and that I
understand the responsibilities of credit card acceptance.
Requested by:
Approved by:
