PIN Pad Order Form

Business Information

For the following set of fields, please enter your business address information.

Your Name(required)

Your Email Address(required)

Company Name(required)

Address 1(required)

Address 2

City(required)

County(required)

State/Province(required)

ZIP/Post Code(required)

Phone Number(required)

Business Contact Information

Please provide your business contact. This address will receive monthly invoices and non-technical communications about your Datacap account.

Name(required)

Email Address(required)

Phone Number(required)

Technical Contact Information

Please provide the contact information to receive ChargeLogic and Datacap service update communications, maintenance communications, and other technical service-related communications.

Name(required)

Email Address(required)

Phone Number(required)

Software Platform

ERP Product(required)

ChargeLogic Apps(required)

Payments

Retail Express

Please tell us the ChargeLogic solution(s) you are using. If you have multiple solutions installed, please check all that apply.

ChargeLogic Solutions(required)

Payments

Retail

Retail Express

Please tell us the ChargeLogic solution(s) you are using. If you have multiple solutions installed, please check all that apply.

PIN Pad Selection

In order to provision your account, we need to know which Datacap PIN Pads you are using or are going to use.

Location and Terminal Configuration

In order to provision your account, we need to know how many locations (merchant accounts) you are using in conjunction with the PIN Pad and how many PIN Pads (terminals) are associated with each location.

Number of Locations (Merchant Accounts)

Number of PIN Pads (Terminals) Total

PIN Pads Per Location

Please list all the location (merchant account) names and the number of PIN Pads (terminals) needed at each location.

Payment Processor

*The preferred platform for ChargeLogic & Datacap PIN Pads is First Data Rapid Connect with the North, Nashville or Buypass front end. Choosing another processor for use with PIN Pads may restrict feature or security options. Please contact us with any PIN Pad or processor questions. Thanks!

Platform(required)

Administrative MID

Merchant ID (Gateway Account ID - 12 digits)

Merchant ID (MID)

Terminal ID (TID)

Front End Platform

Group ID

Merchant Category Code

Merchant BIN (4 digits)

Secret Key

Token Type ID (TransArmor)

License ID

Site ID

Acquirer BIN

Enable Host Duplicate Checking?

Yes

No

Portico Device ID

Portico Username

Portico Password

Batch Close Option (Merchant or Host Initiated by Time):

Client Number (4 digits)

NetConnect User Name

NetConnect Password

Host Capture POS ID (15 digits)

Authentication Code

Zip Code

Host Close Time

ChargeLogic Datacap PIN Pad Order Form

Business Information

Business Contact Information

Technical Contact Information

Software Platform

PIN Pad Selection

Location and Terminal Configuration

Payment Processor