Emarket Checkout Request Form

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Submit this form for a new Emarket Checkout Integration. You will be required to create a MyUCLA Message center case with the receipt of this form.

For more information regarding the UCLA Cashiering Database Checkout integration please see our vendor integration guide or reach out to UCLA Purchasing and UCLA Treasury for more assistance with approved PCI compliant vendors.

All Checkout requests must be vetted by UCLA Purchasing and UCLA Treasury *

For more information, please visit UCLA Treasury regarding PCI and Checkout requirements from Bank of America for all Emarket Checkouts.

I have completed PCI Requirements and can proceed to Cashiering Database Checkout Integration

Attestation of Compliance (AOC)

Verified White Papers

Purchasing approved Vendor

ACM Approved Accounting

Required

Please input your Employee University ID

(Ex. 9-digit Bruincard/UCLA Health ID) *

Department Contact Email

(Ex: jbruin@ucla.edu)
*

Department Main Contact Name:

(Ex. Dr. Josephine Bruin Manager (she/her)

Please input your Department Code

(Ex. 43580 PSC) *

Vendor/Technical Main Contact Name:

(Ex. Mr. Joe Bruin Analyst for UCLA IT (he/him)

Business Customer Service phone number

(Ex. (111)-111-1111)

This is a requirement for payees to contact the department regarding services rendered.

Please input the "Doing Business As" description that will showcase on a credit card statement.

(Ex. UCLA LAW SCHOOL TICKETS)

17 characters maximum (this displays on payers credit card statement with contact business phone #)

Business Physical Address
(Ex. Box 957089, 1125 Murphy Hall

405 Hilgard Avenue
Los Angeles, CA 90095-7089) *

Please input the Income Full Accounting Unit - FAU

(ex. 4-123456-A1-23456-DESCRIPTION) *

If you have additional questions, please visit UCLA Finance for more information.

For questions regarding accounting and cash management, please reach out to askacm@finance.ucla.edu and include the following:
- Specify you are requesting information regarding Emarket Storefront income and expense FAUs.
(Please note: account number must begin with 1or 2)

Please input the Recharge Full Accounting Unit - FAU associated with all UCLA credit card transactions.

PLEASE NOTE: FAUs will be validated and will delay your request if it reflects as invalid.

(ex. 4-123456-A1-23456-XX-XXXX-DESCRIPTION)

For more information, please visit UCLA Treasury regarding Credit Card Fee FY recharges from Bank of America for all Emarket Storefront revenue.

Please estimate the average ticket item.

(Ex. $100)

Please estimate the average annual sales volume.

(Ex. $100,000)

Please select from the options regarding Merchant Identification Numbers (MIDs) *

A merchant ID is required for all new vendors and for updating a specific "Doing Business As" details

I need a new MID

I have a MID

I need to make an update to my MID "Doing Business As" description

I no longer need my MID and wish to close my account

How often will the site be active? *

One Time Use (event/conference)

Periodic Use (multiple events/annually)

Year-Round Use

If site is one time use/periodic use, please insert deactivation date

YYYY

Refund Policy

If not specified, will default to UCLA PSC Ecommerce Terms and Conditions

Date *

YYYY

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