EMV TEST CARD
REQUEST FORM
This request form is to be completed in order to receive 1 Discover® EMV
Production Validation Card and 1 JCB EMV Production Validation Card.
TIMING: Test cards requests can take between 5-10 business days
ALL FIELDS ARE REQUIRED
SHIPPING ADDRESS
FedEx requires an alternate name, phone number and email address
REQUEST DATE
REQUESTOR NAME
NAME
ALT. NAME
TITLE
COMPANY NAME
STREET
PHONE NUMBER
PHONE NUMBER
REQUESTOR EMAIL
CITY
PLEASE DEFINE YOUR
ROLE OR TITLE
PLEASE TELL US SPECIFIC
VERTICALS YOU TARGET
STATE ZIP
EMAIL ADDRESSS
PLEASE IDENTIFY THE PROCESSOR(S)
YOU ARE CURRENTLY WORK WITH:
PLEASE INDICATE IF YOU WORK
WITH THE FOLLOWING GATEWAYS:
o
GATEWAY
o
ISO
o
RETAIL
o CAYAN
o
MERCURY/VANTIV
o
AJB
o
FUSEBOX
o
SWITCH
o
POS OEM
o
RESTAURANT
o ELAVON
o
STERLING
o
BLACKLINE
o
MERCHANT LINK
o
MIDDLEWARE
o
ISV
o
LODGING
o GLOBAL
o
TSYS
o BRIDGEPAY
o OPEN EDGE
o
DEALER/AGENT
o
VAR
o
OTHER*
o FIRST DATA
o
WORLDPAY
o DATACAP
o
SHIFT 4
o
OTHER*
o HEARTLAND
o
OTHER*
o
o
OTHER*
*IF OTHER, PLEASE SPECIFY
*IF OTHER, PLEASE SPECIFY
*IF OTHER, PLEASE SPECIFY
FREEDOMPAY
*IF OTHER, PLEASE SPECIFY
o No, I don’t want to receive periodic email alerts and newsletters from the VARConnection.
Email completed form to: [email protected]