New Customer Profile | IC Payments

General Information

Desired Live Date* *

Your Name *

Your Email Address *

Financial Institution *

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Primary Bank Number *

Primary Bank Address *

City *

State/Province *

ZIP / Postal Code *

Country *

Technical Contact Information

Technical Contact Name *

Technical Contact Phone *

Technical Contact Email *

Technical Acknowledgements

This is an acknowledgment that I or my team, have provided our technical team, as well as our Network Administrators and Firewall Administrators (if applicable) with the Technical Requirements documented on the last page of this program profile. *

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This is an acknowledgement that our Financial Institution can meet the DHCP Networking Requirements that are outlined within the Technical Requirements on the last page of this program profile. *

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Do you plan on using a virtual or ‘thin client’ environment in conjunction with Card@Once Pin pads? *YESNO* I understand that Card@Once does not support the use of PIN pads in a thin client environment.

Set Up

What programs will you offer with Card@Once? (Please include BIN Number and Program Name/Type) *

Have you notified your Core and Processor about starting an Instant Issuance program? *YESNO

Name of Company that processes card transactions: *

Name of Core System software used in branch: *

Do you plan on using a printing or activation integration/interface with Card@Once? *YESNO

Are you able to provide Card@Once with DES/PVK/PIN secure keys for each BIN? *YESNOA request has been made*Please contact core/processor for assistance with these questions

Are you able to provide Card@Once with CVV/CVK secure keys for each BIN? *YESNOA request has been made*Please contact core/processor for assistance with these questions

Are you able to provide Card@Once with EMV secure keys for each BIN? *YESNOA request has been made*Please contact core/processor for assistance with these questions

Are you able to provide Card@Once with a valid card number for a new and/or existing cardholder? *YESNOA request has been made*Please contact core/processor for assistance with these questions

Are you able to provide Card@Once with an expiration date for a new and/or existing cardholder? *YESNOA request has been made*Please contact core/processor for assistance with these questions

Are you able to upload a PIN offset into your current Core System software? *YESNOA request has been made*Please contact core/processor for assistance with these questions

Please confirm if your customer’s PINS are currently validated off the physical card/plastic or off of a hosted system: *PINS validated off cardPINS validated off host systemNot Sure

Please select all options you offer your cardholders today to change their PIN number: *IVR/VRU/Phone PIN ChangeATM PIN ChangeIn-Branch PIN ChangeIssue New CardN/A - No PIN Change Option OfferedOther

If other, please explain:

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Equipment

Which option do you plan on using with the Card@Once printer? *Edge 2 Edge/Color Printing - Full color printing of background design, back verbiage, and personalization with a color ribbon on white cardstockPrinting on Pre-Printed Stock - Bank logo, network bugs, and verbiage may be printed as well as cardholder personalization only on pre-printed stock

Plastics

What type of cardstock will be used for Card@Once?

Color Ribbon compatible: *Generic Blank White (can be purchased through Card@Once)

Black or Silver compatible: *Custom PlasticGeneric Pre-Printed Plastic

Plastics will be manufactured by: *IC PaymentsOther Vendor

If Other, please list:*Please verify chip compatibility and needs with Card@Once if requesting to use Other Vendor for EMV stock fulfillment

The order for plastics has been submitted: *YESNO

Artwork

What type of artwork will be used for Card@Once Edge 2 Edge printing? *Custom Design - Supplied by Institution. Please see the Card@Once Art Requirements Document for specifications.Generic Background - Institution will choose a stock image from IC Payments’ Print Ready Gallery and additionally will supply IC Payments with a VECTOR logo, back verbiage, and list of preferred Network logos.N/A if using Black or Silver Ribbon print process

Site Information

Which branches will offer Card@Once?

Total Number of printers requested: *

Total Number of PIN Pads requested: *

Physical Address of Branch locations:*

*If more than 10 printers, fill out below information on a spreadsheet and return with Program Profile document.

Street address

City

State/Province

ZIP / Postal Code

Country

Street address

City

State/Province

ZIP / Postal Code

Country

Street address

City

State/Province

ZIP / Postal Code

Country

Street address

City

State/Province

ZIP / Postal Code

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Street address

City

State/Province

ZIP / Postal Code

Country

Street address

City

State/Province

ZIP / Postal Code

Country

Street address

City

State/Province

ZIP / Postal Code

Country

Street address

City

State/Province

ZIP / Postal Code

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Street address

City

State/Province

ZIP / Postal Code

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Street address

City

State/Province

ZIP / Postal Code

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Institution Administrators

Who should have the ability to set-up users and assign employee permissions?

Name *

Email Address *

Name

Email Address

Name

Email Address

EMV Setup

Which BINs should be EMV and how should they be programmed? • Completion of this page is ONLY required if implementing EMV programming • Some questions may require the assistance of your transaction processor to answer. If you are unable to answer any of the questions below, please leave field blank and your Card@Once Implemenation Specialist will discuss them with you at time of project kick-off.

Please list BIN Number, Payment Brand Type, EMV Profile Specification, Chip Type, and Transaction Processor for each: *0 / 180

Are you currently issuing EMV cards on the above BIN(s) today? *YESNO

Does your institution participate in US Common Debit AID? *YESNO

Does your institution issue duplicate PAN numbers to separate members at any time? *YESNO

Can you confirm the PAN Sequence Number your processor uses for EMV programming? *YESNO

If YES, this value should be hardcoded to:

Can you confirm the Key Derivation Index (KDI) used by your processor? *YESNO

If YES, this value should be:

If a MasterCard issuer, does your institution allow for Offline (non-internet) Transactions?YESNO

If YES, please list: Lower Consecutive Offline Limit (Tag 9F14):

If YES, please list: Upper Consecutive Offline Limit (Tag 9F23):

If YES, please list: Lower Cumulative Offline Transaction Amount (Tag CA):

If YES, please list: Upper Cumulative Offline Transaction Amount (Tag CB):