ChargeLogic Datacap PIN Pad Order Form

Business Information

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

Business Contact Information

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

Technical Contact Information

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

Software Platform

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

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.

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!