Begin the Self Assessment Questionnaire

IMPORTANT: It is important that you provide accurate answers to all of the questions. Therefore, you may find it necessary to consult with a person with IT (Information Technology) expertise, as some of the questions may be technical in nature. It is also important that the person answering these questions, understand your credit card processing environment. Please also note that in the event that a question does not pertain to your merchant credit card processing environment and the option of N/A (Not Applicable) is given, it is acceptable to choose N/A.

Initial questions:
1 Do you use a computer in your work environment?
  • Yes
  • No
2 Does it have access to the Internet?
  • Yes
  • No
3 Do you use this computer to process your credit card transactions?
  • Yes
  • No
4 Do you store cardholder information on this computer?
  • Yes
  • No
5 Do you use a wireless credit card terminal to process your credit card transactions?
  • Yes
  • No
5.a Does your computer use the same wireless connection?
  • Yes
  • No
6 Do all of your credit card terminals use a standard phone connection to dial out?
  • Yes
  • No
7 Does your credit card terminal use a high speed line to dial out? (ex. Ethernet cord connected to the back of the terminal)
  • Yes
  • No
7.a Does your computer use the same Internet connection as your credit card terminal?
  • Yes
  • No
8 Do you have a website in which you process credit card transactions or store customer card data?
  • Yes
  • No
8.a If you have a website, do you ever log on to the site and enter credit card transactions?
  • Yes
  • No

Please identify yourself:
DBA Name:   Example: Tom's Lawncare
Corporate Name:   Example: Acme Lawncare Incorporated
Full name:   Example: Tom Jones
Address:  
City, State, Zip:    
Phone:   Example: 555-555-5555
Email:   Example: tom@someplace.com
Confirm Email:   Retype your email address

Type of merchant business (check all that apply):

Retailer Telecommunication Grocery and Supermarkets
Petroleum E-Commerce Mail/Telephone Order
Others (please specify)
List facilities and locations included in PCI DSS review:
(If one location, enter street address)

Relationships

Does your company have a relationship with one or more third-party service providers (for example, gateways, web-hosting companies, airline booking agents, loyalty program agents, etc)?
Yes        No
Does your company have a relationship with more than one acquirer?
(Do you use more than one processing company or bank for your credit card transaction processing?)
Yes        No

Transaction Processing

Payment Application in use:
(Credit card terminal or software name.)
If software, please list version:
 
 
   

 

 

First Financial USA Merchant Services 805 Meander Ct Medina MN 55340