Fillable Sfin Emarket Site Request Form 3.18 Secure (California State University, Chico)

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Sfin Emarket Site Request Form 3.18 Secure (California State University, Chico)

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SFIN: eMarket Site Request Form Page 1 Updated March 2018
CALIFORNIA STATE UNIVERSITY CHICO
FINANCIAL SERVICES
STUDENT FINANCIAL SERVICES
STUDENT SERVICES CENTER
ROOM 230
CHICO, CA 95929-0242
530-898-5936
www.csuchico.edu/sfin
eMarket Site
Request Form
Purpose: CSU Chico has the ability to set up eMarket payment sites to accept online payments on behalf of campus
departments for authorized services/products/fees. Customers are connected from a department website to a
customized eMarket storefront or checkout site where they may select and securely pay for items via credit card and/or
eCheck/ACH. eMarket payment sites are compliant to Payment Card Industry Data Standards (PCI DSS). Payments
received are deposited directly to the University’s bank account and posted to the general ledger.
DEPARTMENT INFORMATION
Department Name:
Primary Contact: Phone Ext.:
Email: Campus Zip:
Dept. Head/Administrator Name:
eMARKET INFORMATION
Products/events/services offered through the eMarket site must be approved by the University. Fees must be
authorized and documentation will be required.
Purpose of the eMarket site:
FEE INFORMATION
FEE 1:
Description AMOUNT
Account Fund Dept ID Program Class
FEE 2:
Description AMOUNT
Account Fund Dept ID Program Class
SFIN: eMarket Site Request Form Page 2 Updated March 2018
eMARKET SITE INFORMATION:
Date eMarket is needed for service/end date (if applicable): Start Date: End Date:
Will the primary users be currently enrolled students?
Yes
No
If not students, who?
What information should be collected at time of purchase? (E.g. name, phone, email, etc.)
Should an inventory level be set?
Yes
No
If yes, what level?
What forms of payment will you accept?
Electronic Checks (ACH)
Credit Cards
Will the department pay the credit card fee* (currently 2.5%)?
Yes
No
If not, the external processing fee (currently 2.75%) will be passed to customers.
If the department is absorbing the 2.5% convenience fee for each credit card transaction, please identify the
chartfield where the expenses should be charged: 613P02
Account Fund Dept ID Program
What reporting does the department require?
Comments/additional notes:
AUTHORIZATION
Functional Contact:
PRINT NAME SIGNATURE DATE
Appropriate Administrator/Chair:
PRINT NAME SIGNATURE DATE
Director, Student Financial Services:
PRINT NAME SIGNATURE DATE
INTERNAL USE ONLY
Approved
Denied
Reason (for denial):
Merchant: Operator: Station:
CC pymt code: ACH pymt code:
Item codes:
References:
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Completed 19 July 2020

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