Accounts Receivable AR03
MERCHANT ID & POINT-OF-SALE (POS) REQUEST FORM
Purpose of Form: The Merchant ID and Point-of-Sale (POS) terminals are options for departments to
provide their customers additional modes of payments (debit/credit cards, online, etc.). Please use this
form when you wish to request a Merchant ID and POS machine.
1. Requestor Information:
Name: _________________________________ Ext: ______ Email: _______________________
Department: ____________________________
2. The Purpose of Inquiry:
> Provide information on why you need the machine?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
> Do you already posses any machines? Yes No
3. Point-of-Sale Terminal and Payment Processing Online Information:
> There are two options in which payments can be processed: Point-of-Sale Terminal or Payment Processing
Online. Below are the links where you can find the information about the machines available:
POS terminal payment: https://en.chasepaymentech.ca/pos_payments.html
Online payment processing: https://en.chasepaymentech.ca/online_payment_processing.html
> Please choose the payment processing type and product you want to use:
POS terminal payment Please select an item.
Online payment processing Please select an item.
> If the POS terminal payment is selected above, how many machines will you require? ___________
> Please provide the account in which the monthly equipment and bank fees will be charged:
______________________________
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Please Select an Option
Please Select an Option
4. Authorization:
Your typed name below indicates your approval of the form and confirms that all information is accurate.
Name: _____________________________________ Date: _________________
Department: ________________________________
Once completed, please submit this form to Accounts Receivable / Finance Department:
Dannielle.Quenneville@uwindsor.ca
If there are any questions while filling out the form, please contact: Dannielle Quenneville by phone at
ext. 2125 or by email at Dannielle.Quenneville@uwindsor.ca
FINANCE DEPARTMENT USE ONLY
Approved by: _____________________ Date: __________________
Comments: _______________________________________________________________________________
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