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By signing this document, I certify that I have read and agree to abide by all terms of the Rowan University PCI (Payment Card Industry) Policy (https://go.rowan.edu/pci), and that upon approval to receive a credit card reader, I will take appropriate action necessary to ensure that all staff members who will be processing credit card payments using that reader will abide by the terms of the Rowan University PCI Policy, and will also complete all security awareness training that is required by the PCI Compliance IRT.
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Department:_______________________________________________________________________________________________Reason for request: _________
Reason for request: ______________________________________________________________________ ______________________________________________________________________
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Name of Person Initiating the Request (Please Print):
___________________Name of Person Initiating the Request (Please Print): _______________________________________________________
Signature of Person Initiating the Request:
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Name of Department VP (Please Print):
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Signature of Department VP:
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