IEEE Credit Card Processing Agreement Form

Enter the details for your conference.

1. Name of Conference:*
2. Conference Number:
3. Number of Attendees:
4. Conference Location:
5. Date Conference Starts:
   (mm/dd/yyyy)
6. Date Conference Ends:
   (mm/dd/yyyy)
7. Date Terminal ID is needed by:*
   (mm/dd/yyyy)
8. Date Terminal ID can be terminated:
   (mm/dd/yyyy)

Enter the name of the person filling out this form. You will be contacted regarding the requested service.

1. Name:*
2. Phone:*
3. E-mail:*
4. Title/Position:*

Enter the name of the person who will be responsible for reconciling the merchant lending account. You may be contacted regarding any questions about specific transactions or transfers of proceeds for the account.

1. Name:
2. Phone:
3. E-mail:

IEEE is required to follow global Payment Card Industry Data Security Standards (PCI DSS) (also known as PCI Compliance) to ensure that your conference registration payment process is maintained in a secure environment. This regulation applies to any merchant that utilizes a Merchant ID.

How will the conference receive credit card information?
Online Phone, fax or mail All Methods

Has a service provider been hired to process registrations?
Yes No

Does the conference intend to use a self-built registration system?
Yes No

1. Who is the gateway provider that will be processing credit card payments? (e.g. PayFlowPro, Authorize.net, Cybersource, etc.)
   

Note: Payment processing software/gateway must be able to process on First Data platforms.