Attestation of Compliance, SAQ C-VT

The merchant must complete this Attestation of Compliance as a declaration of the merchant’s compliance status with the Payment Card Industry Data Security Standard (PCI DSS) Requirements and Security Assessment Procedures. Complete all applicable sections and refer to the submission instructions at PCI DSS Compliance – Completion Steps in this document.

Part 1. Merchant and Qualified Security Assessor Information. SAQ C-VT

This application form is made up of multiple parts. Please complete all parts in order for us to process your application properly.
Database Adminitrator
Street Address
State/Province/Region
Zip/Postal Code