PCI Election

Make your required PCI election in a few quick steps.

Step 1 of 5

Your Business & Primary Contact

Help us link this PCI election to the correct merchant account and primary contact.

Business Name*

Merchant ID*

Must be 10 digits and begin with 8.

First Name*

Last Name*

Email Address*

Business Phone*

Main business line for PCI-related communications.

Mobile Phone

Optional, but helpful for time-sensitive items.

Text Me Ticket Updates

Receive status alerts for PCI-related tickets at your mobile number.

No Yes

By signing up for Velocity's support ticket alerts, you consent to receiving text updates at the mobile number you provided, and to Velocity's Terms of Use and Privacy Policy. Message and data rates may apply. Reply STOP to cancel.

PCI SAQ / Network Vulnerability Scan Selection

A PCI Self-Assessment Questionnaire (PCI SAQ) is a merchant's statement of PCI compliance. It's a way to show that you're taking the security measures needed to keep cardholder data secure at your business. Each SAQ includes a list of security standards that businesses must review and follow. Depending upon the method(s) for accepting payments, the hardware and/or software utilized, and other parameters associated with your account, the SAQ may be lengthy, the questions may be technical, and the terminology may be difficult to understand. Unless you are highly skilled in completing PCI SAQs or have a third-party vendor that is a certified Qualified Integrator & Reseller (QIR), we recommend that you select the option requesting Velocity Processing's assistance (Option 2).

Option 1 – Complete PCI SAQ & Scan Independently

We will complete the PCI SAQ and network vulnerability scan independently.

Option 2 – Velocity-Assisted PCI SAQ & Scan Recommended

We request Velocity Processing's assistance to complete the PCI SAQ and network vulnerability scan. [RECOMMENDED]

Option 3 – PCI-Certified Third-Party

We will use a PCI certified third-party to complete the PCI SAQ and network vulnerability scan.

Environment & Network

Tell us how you process payments and how your network is configured.

Scan Selection*

Indicates whether a network scan is required for your environment.

ISP Status*

Are Terminals At The Office?*

Annual Environment Changes?*

Indicates if you expect material changes to your environment annually.

IPv4 Address (Optional)

Each block must be between 0 and 255.

Speak With Velocity?*

PCI Acknowledgements

Please review and confirm each statement regarding your PCI responsibilities.

Acknowledgements*

Check each statement to confirm your understanding and agreement.

PCI DSS compliance is mandatory for every business in the United States. I understand that PCI DSS compliance is mandatory. PCI DSS compliance must be completed every year, even if there are no changes to the processing hardware, software, and/or payment acceptance methods. I understand that the PCI SAQ must be completed every year. PCI DSS compliance is based on your existing hardware, software, and payment acceptance methods. If anything changes, please notify Velocity Processing so that we can update your PCI SAQ accordingly. I understand that I must notify Velocity Processing immediately if my organization changes the hardware/software used to accept payments to ensure that my PCI SAQ is updated. The card brands (Visa, Mastercard, American Express, and Discover) will charge non-compliant fees for accounts that are not PCI compliant. Velocity Processing sends out automated emails (60 days prior to the renewal date) reminding clients of their upcoming PCI compliance renewals. Additionally, we will make every effort to email, call, and/or text you as a reminder to complete the PCI election form. I understand that my organization will be subject to monthly non-compliant fees if we do not complete the PCI SAQ, renew our PCI SAQ, or pass a network vulnerability scan (if applicable). We have a dedicated support team that can answer questions regarding PCI DSS compliance, network vulnerability scans, and network vulnerability reports. Our PCI team can be reached at 855-750-0747. I understand that I can always receive assistance by calling the PCI DSS Compliance support team at 855-750-0747. It is the responsibility of the business to protect and safeguard cardholder data. All hardware and software provided by Velocity Processing is PCI DSS compliant. Please be certain to keep all paper documents containing cardholder information in a secure location. I understand that my organization is fully responsible for protecting cardholder data. It is the responsibility of the business to protect and safeguard cardholder data. Velocity Processing strongly discourages the use of full card numbers on credit card authorization forms. We also discourage the use of email for exchanging cardholder data unless you are certain that your business is using a secure email application. I understand that my organization should never request full debit/credit card numbers via email unless I am using a fully encrypted end-to-end secure email platform. This includes requesting signed credit card authorization forms. It is the responsibility of the business to protect and safeguard cardholder data. Velocity Processing encourages that all electronic forms collecting cardholder data use an encryption technology that securely captures the data. Additionally, we discourage the use of forms that utilize plain text / unencrypted emails that provide and/or store full card numbers after the form has been submitted. I understand that my organization should never use any electronic forms to collect full debit/credit card numbers unless I am certain that my form system is using a fully encrypted end-to-end secure platform and does not send email receipts containing full card numbers. The card brands (Visa, Mastercard, American Express, and Discover) prohibit the electronic storage of the CVV code. While it is highly encouraged to obtain and enter the CVV code when processing a transaction, the code must never be stored. I understand that the card brands (Visa, Mastercard, American Express, and Discover) prohibit the storage of the card code, often referred to as the CCV code, the CVV code, or the CVC2 code. The card brands (Visa, Mastercard, American Express, and Discover) require the creation and implementation of an Information Security Policy (ISP). If you do not currently have an ISP, you can download the template below at no cost. I understand that my organization must have an Information Security Policy (ISP).

Signature

Please sign to confirm that the information provided in this PCI election is accurate.

Signature*

Sign using your mouse or finger. Your signature confirms the accuracy of the information above.

By signing, you acknowledge your PCI election selections.