Merchant Services

Certify and Grow Your Business

Integrate your software with us and discover how the power of the Chase Paymentech ecosystem can help you achieve your financial goals. Complete this form and one of our Research & Discovery representatives will contact you within two business days for an evaluation.

All fields are required unless indicated.

General Company Information

  • Date:
  • Company Name:
  • DBA Name:
  • Where is the company domiciled?
  • Phone:
  • Company Address:
  • City:
  • State/Province:
  • ZIP/Postal Code:
  • Country:

Contact Information

  • Business Contact First Name:
  • Business Contact Last Name:
  • Business Contact E-mail:
  • Business Contact Phone Number:
  • Tech Contact First Name: optional
  • Tech Contact Last Name: optional
  • Senior Management Contact First Name:
  • Senior Management Contact Last Name:
  • Senior Management Contact E-mail:
  • Senior Management Contact Title:
  • Tech Contact Phone Number: optional
  • Tech Contact E-mail: optional

Detailed Company Information

  • Web Site:
  • Year Established:
  • Number of Employees: optional
  • Company Overview:
  • Competition / Differentiation: optional

    (Alternatives that are available to your solution and how your solution will differ)

  • Market Strategy: optional

Compliance Information

  • Are you a Service Provider? Yes   No   N/A  
  • Do you have an AOC? Yes   No   N/A  
  • Do you have a SAQ-D? Yes   No   N/A  
  • Are you Registered? Yes   No   N/A  
  • Have you paid your annual Third Party Registration Fees for the Card Brands? Yes   No   N/A  
  • Registered with which acquirers?
  • Partner QSA
  • Are you a Software Vendor? Yes   No   N/A  
  • Is your Solution PA-DSS validated? Yes   No   N/A  
    Your Validated Version:
    When will you be compliant?
  • Do you have an AOV? Yes   No   N/A  

Partnership Information

  • Incentive for Partnering with Chase Paymentech: optional
  • Identify Existing Processor Relationships:

Business Verticals

  • (Select all that apply; at least one choice is required)
Use the shift key to select items in a row.
The Control or Alt keys can be used to to select multiple items.

Portfolio Profile

  • Number of Existing Merchants using your solution across all acquirers:
  • Projected New Merchants Per Month to Chase:
  • Average Annual Merchant Sales Volume:
  • Average Annual Merchant Sales Transactions:
  • List Merchant's driving integration:
  • Detail the Transactional Flow from customer to Chase

Transactional Data

(Select all that apply; at least one choice is required)

Use the shift key to select items in a row.
The Control or Alt keys can be used to to select multiple items.
  • Additional Information optional

Certification

  • What are the features and functionalities you want to certify for?