Chase Paymentech

Certify and Grow Your Business with Chase Paymentech

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: Phone:
Company Name: DBA Name:
Company Address: City:
State/Province: ZIP/Postal Code:
Contact Information
Business Contact First Name: Business Contact Last Name:
Business Contact Phone Number: Business Contact E-mail:
Tech Contact Name: optional Tech Contact E-mail: optional
Tech Contact Phone Number: optional    
Detailed Company Information
Web Site: Year Established: optional
Number of Employees: optional Federal Tax ID: optional
Company Overview:
(Brief description of the solution and the business need it solves)
Competition / Differentiation: optional
(Alternatives that are available and how this solution will differ)
Target Market / Size of Market: optional
(For whom are you solving and how big is the opportunity)
Market Strategy: optional
(How will this solution get to market)
Compliance Information
Are you a Service Provider?

Yes   No  
Are you a Software Vendor?

Yes   No  
If you are a Service Provider, please provide registrations: optional
Examples: Third Party Agent (TPA), Third Party Processor (TPP), Third Party Submitter(TPS)


If you are a Software Vendor, is your solution PA-DSS validated? optional
Yes   No
If yes, validated version: optional  
If no, when will you be compliant?
optional
Partner QSA:
optional
 
Have you paid annual Visa© and/or
MasterCard© Third Party Registration Fees?
Yes   No   Not Applicable   

 

Are you listed as an approved vendor or service provider? optional
Yes   No
If yes, under what name? optional  
Link to Listing: optional  
Partnership Details
Incentive for Partnering with Chase Paymentech:
(What functions are critical for success)
Identify Existing Processor Relationships:
(Are you currently in partnership, and with whom)
Business Verticals
(Select all that apply; at least one choice is required)
Portfolio Profile
Existing Merchants: optional Projected New Merchants Per Month: optional
Avg. Annual Merchant Sales Volume: optional Avg. Annual Merchant Sales Transactions: optional
Transactional Data
(Select all that apply; at least one choice is required)
Email address Driver's license number
Date of birth National ID (SSN or foreign country)
Age Digital or electronic signature
Marital status Account transactions
Gift card / Ranges Credit bureau score
Debit card number