Instructions for Completing
JMU Payment Card Change Request

Contact Name:   Person making the request

Date:   Current date

Office or Department:   Department making the request

Phone:   Phone number of the person making the request

Email:   JMU email address of the person making the request

Fax:   Fax number of the person making the request

  • Provide a description of the current business activity for which you would like to change or provide a description of the additional activity that you are requesting.
  • Provide an outline of the activity request by describing how the change supports business strategy, plans or programs.
  • Check the additional box if the request involves an additional (new) merchant account. Check existing and provide the number if the request does not involve additional (new) merchant numbers.
  • Provide a description of the payment system involved. Provide the payment card terminal name and model number and for web-based payment systems provide the software name and version.

Obtain all the appropriate signatures.