Can the template be electronically signed?

Yes. Electronic signatures are legally valid under the ESIGN Act and UETA for most transactions when intent, consent, attribution, and retention are demonstrated; include a consumer disclosure if required by law.

When is notarization required?

Notarization is rarely required for internal PCI attestations. Only obtain notarization when a contractual party or specific state law requires it for the particular attestation.

What if vendor PCI status is unknown?

Document outreach attempts and include a remediation plan. Obtain the vendor's Attestation of Compliance (AOC) or require a contractual obligation to achieve PCI compliance within a specified timeframe.

How do I fix mismatched signer names?

Correct the signer name to match official records, re-execute the attestation where necessary, and attach an explanation and supporting identity documentation to avoid acquirer rejection.

Which file formats should I keep?

Store signed PDFs as the canonical record; retain source DOCX or XLSX files where changes may be needed, and export audit trails in a tamper-evident format for assessors.

How to retrieve an audit trail?

Use your eSignature platform's audit log export. Ensure logs include timestamps, IP addresses, signer email, and action history to satisfy assessor evidence requirements.

Business PCI Template

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

BUSINESS PCI TEMPLATE

Parties

Company Name:

Company Address

Service Provider Name:

Service Provider Address

Recitals

WHEREAS, Company operates merchant services and accepts payment card data in connection with its business operations and requires that payment card data be collected, transmitted, stored and processed in accordance with applicable Payment Card Industry data security standards; and

WHEREAS, Service Provider represents that it provides services involving the storage, processing or transmission of payment card data on behalf of Company and has described the services and scope to be provided in this Agreement; and

WHEREAS, the parties wish to set forth their respective duties and obligations with respect to data security, PCI compliance, payment services, remediation, audits and related responsibilities.

Scope of Work

Service Provider shall provide the services described below. The description must identify all systems, responsibilities, and limits to the environment in which payment card data is in scope.

Payment Terms

Compensation Amount Payment Schedule Late Fee

Late payment shall incur interest of per month, subject to a minimum late fee of .

Term and Termination

This Agreement commences on and shall continue until unless earlier terminated pursuant to this section.

Termination Notice

Either party may terminate for material breach if the breaching party fails to cure within the notice period provided above after receipt of written notice specifying the breach. Termination shall be without prejudice to any accrued rights or liabilities.

Confidentiality and PCI Security Obligations

Each party shall protect Confidential Information of the other with at least the same degree of care it uses to protect its own Confidential Information, but no less than reasonable care. Confidential Information includes payment card data, authentication data, and any information designated as confidential.

Service Provider shall: (a) maintain and demonstrate compliance with applicable Payment Card Industry Data Security Standards (PCI DSS) for all systems and processes within scope; (b) implement and maintain encryption of cardholder data at rest and in transit where applicable; (c) enforce least-privilege access, unique user IDs, and multi-factor authentication for administrative access; (d) perform routine vulnerability scanning and penetration testing and remediate findings within agreed timelines; and (e) maintain logs, monitoring and incident detection controls sufficient to meet PCI requirements.

Attestation of PCI Compliance

Service Provider shall provide Attestation of Compliance or equivalent evidence of PCI compliance upon request and at least .

Breach Notification and Response

Upon discovery of an actual or suspected compromise of cardholder data, the discovering party shall notify the other party without undue delay and no later than calendar days from discovery. Service Provider shall: (a) immediately contain and remediate the incident; (b) preserve and provide logs and forensic evidence; (c) cooperate with regulatory and card brand inquiries; and (d) implement corrective actions to prevent recurrence.

Audit and Assessment Rights

Company retains the right to require assessments or audits (including on-site reviews and penetration tests) of Service Provider's controls that are within PCI scope. Assessments shall be performed no more frequently than unless a material security event warrants immediate review. Service Provider shall remediate deficiencies within days of written notification.

Indemnification and Liability

Service Provider shall indemnify, defend and hold harmless Company from and against any third-party claims, losses, liabilities, costs and expenses (including reasonable attorneys' fees) arising from Service Provider's breach of its obligations under this Agreement or failure to maintain PCI-compliant controls.

Except for indemnification obligations and willful misconduct, each party's aggregate liability under this Agreement shall be limited to direct damages up to the total amount paid by Company to Service Provider under this Agreement in the twelve (12) months preceding the event giving rise to the claim. Neither party shall be liable for consequential, incidental, special or punitive damages.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict-of-law principles.

Entire Agreement

This Agreement, including any exhibits, attachments or appendices expressly incorporated, constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior and contemporaneous agreements, proposals, or understandings, whether written or oral.

Notices

Company Notice Contact Service Provider Notice Contact

Miscellaneous

If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect. No waiver of any breach shall be deemed a waiver of any subsequent breach.

Company:

By:

Date:

Service Provider:

By:

Date:

What the Business PCI Template Is and when it helps

The Business PCI Template is a standardized, fillable document designed to help U.S. businesses record and manage Payment Card Industry Data Security Standard (PCI DSS) compliance tasks, evidence, and internal controls. It consolidates merchant environment details, cardholder data flows, network segmentation notes, required technical and administrative controls, third-party processor relationships, and remediation plans. The template is intended to produce a clear attestation record for internal auditors, acquiring banks, and Qualified Security Assessors (QSAs). It supports electronic completion and e-signature consistent with ESIGN and applicable state UETA/ESRA rules.

Why this template matters for compliance and audits

Using the Business PCI Template centralizes evidence, clarifies control ownership, and reduces audit time by structuring required documentation. It supports consistent adherence to PCI DSS objectives and streamlines validation for assessors, acquiring banks, and internal compliance teams.

Who commonly prepares and signs this template

Typical users of the Business PCI Template include internal compliance teams, IT security staff, and merchant operations.

Merchant acquiring departments managing card acceptance and reporting across retail and eCommerce channels.
IT and security teams documenting network segmentation, encryption, logging, vulnerability scanning, and monitoring controls.
Compliance officers preparing attestations, audit packages, and responses for Qualified Security Assessors and acquiring banks.

Small businesses, service providers, and third-party vendors also use the template to standardize PCI documentation.

Core sections to include in a professional Business PCI Template

Primary sections in a Business PCI Template define scope, controls, evidence, vendor assessments, remediation, sign-off, and reporting timelines for auditors and acquiring partners.

Scope

Describe the cardholder data environment, payment channels (eCommerce, POS), included locations, excluded systems, and network segmentation that limit PCI scope for assessment purposes.

Controls

List technical and administrative controls mapped to PCI DSS objectives: firewalls, encryption, access controls, logging, vulnerability management, patching schedules, and responsible owners.

Evidence

Reference logs, configuration screenshots, ASV/scan reports, policies, training records, and transaction samples that demonstrate controls are implemented and operating effectively.

Third Parties

Record payment processors, gateways, hosting providers, and their PCI status, contract terms, contact points, and delineation of cardholder data responsibilities.

Remediation

Track open findings with risk ratings, remediation owners, target completion dates, verification steps, and required post-remediation evidence for assessor review.

Sign-off

Include attestation language, executive or compliance officer approvals, effective dates, and the method of signature (wet, RON, or e-signature) with audit-trail reference.

Essential fields and required information

Business Legal Name: Full registered legal name.

Merchant ID: Acquirer or processor merchant identifier.

Cardholder Environment: Systems that store, process, or transmit cardholder data.

Third-Party Processors: Vendor names and PCI status.

Control Owner: Responsible individual's name and contact.

Evidence Location: Storage path or system for artifacts.

Penalties and legal/operational risks to note

Cardholder Data Breach: Potential fines, remediation, FTC inquiry, and breach response costs.

Acquirer Penalties: Monetary fines, increased monitoring, or termination by acquiring bank.

Brand Damage: Loss of customer trust and revenue due to publicized incidents.

Contract Termination: Processor or vendor termination risk and loss of payment capabilities.

Liability Exposure: Civil litigation and regulatory scrutiny for inadequate controls.

Operational Disruption: Service outages, fraud losses, and recovery costs.

Common mistakes when preparing a Business PCI Template

Failing to define scope clearly, which leads to omitted systems and incomplete attestations that later require rework during assessment.
Submitting incomplete evidence or screenshots without timestamps, making it difficult for assessors to verify continuous control operation.
Using inconsistent dates or mismatched signer names, which can invalidate attestations or trigger request-for-information cycles from banks.
Neglecting to record third-party PCI responsibilities, leaving gaps where processors or vendors are assumed to be compliant.

Step-by-step: complete a Business PCI Template

Follow these steps to populate the template for internal review and external assessment, ensuring evidence and ownership are clearly assigned.

01

Prepare Scope: Define cardholder data flows and systems in scope for this assessment.
02

Gather Evidence: Collect logs, scan reports, screenshots, policies, and training records.
03

Assign Owners: Record responsible individuals and remediation deadlines for each finding.
04

Sign & Archive: Obtain required attestation signatures and store with audit trail.

Where to send or file the completed template

Typical routing for completed Business PCI Templates involves internal review, assessor validation, and delivery to acquiring banks or retention in secure records.

Internal Review: Compliance team verifies controls and attached evidence.
QSA Submission: Provide the template and supporting evidence package to the Qualified Security Assessor.
Acquirer Notification: Share attestation with acquiring bank upon request or per contract.
Record Retention: Store the signed template and artifacts per retention policy.

Technical and platform requirements for eSubmission

Choose eSignature and document platforms that provide tamper-evident audit trails, configurable signer authentication, and export to common formats for evidence retention.

Integrations: Salesforce, NetSuite, Microsoft 365, Google Workspace, Box, and Egnyte integrations support workflow automation.
Formats: PDF, DOCX, HTML, and Excel exports preserve evidence for audits.
Authentication: Email links, SMS one-time codes, knowledge-based checks, and SSO options.

Recommended digital workflow settings

Configure an electronic workflow to collect, review, and retain Business PCI Template responses with verification steps and secure storage.

Field	Configuration
Signer Authentication	Email link, SMS OTP, or SSO as available.
Field Validation	Use required fields, format patterns, and conditional logic to reduce errors.
Document Routing	Sequential approval, optional reviewers, and bulk send for multiple merchants.
Audit Trail Level	Capture full action logs, timestamps, and IP addresses for each signer.

Compare e-signed templates with paper workflows

Compare electronic completion with traditional paper workflows for Business PCI Templates to assess differences in authentication, speed, and audit readiness.

Criterion	eSign	Paper
Authentication	email/sms/kba	photo id/witness
Processing Time	under 24 hours	days to weeks
Audit Trail	detailed digital log	manual notes
Storage	encrypted cloud	physical files

eSignature pricing and capability comparison

Pricing and capabilities for common eSignature providers to consider when implementing e-submission for a Business PCI Template.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Key recurring deadlines and cadence to track

Plan recurring scans, attestations, and remediation deadlines to remain compliant and prepare evidence before assessments.

Annual Assessment:

Complete annual SAQ or ROC as required by card brands and acquirers.

Quarterly Scans:

Perform external ASV scans quarterly for applicable environments.

Remediation Targets:

Assign remediation deadlines with owner and verification steps; prioritize critical findings immediately.

Vendor Re-checks:

Verify third-party PCI attestations annually or on contract renewal.

Acquirer Reporting:

Report confirmed breaches to acquiring bank per contractual timelines; act immediately on suspected compromises.

Key milestones and processing stages

A sequential milestone view helps teams coordinate scope, evidence collection, and final attestation for assessors.

01

Define Scope

Identify in-scope systems and payment channels before evidence collection.

02

Collect Evidence

Gather logs, scans, screenshots, and vendor attestations.

03

Internal Review

Compliance reviews entries, confirms completeness, and assigns remediation.

04

External Assessment

Submit the package to a QSA or provide SAQ and evidence to the acquirer.

Frequently asked questions and quick troubleshooting

Answers to common questions about completing, signing, and storing the Business PCI Template to avoid delays and assessment issues.

Need help? Contact support

Can the template be electronically signed?
Yes. Electronic signatures are legally valid under the ESIGN Act and UETA for most transactions when intent, consent, attribution, and retention are demonstrated; include a consumer disclosure if required by law.
When is notarization required?
Notarization is rarely required for internal PCI attestations. Only obtain notarization when a contractual party or specific state law requires it for the particular attestation.
What if vendor PCI status is unknown?
Document outreach attempts and include a remediation plan. Obtain the vendor's Attestation of Compliance (AOC) or require a contractual obligation to achieve PCI compliance within a specified timeframe.
How do I fix mismatched signer names?
Correct the signer name to match official records, re-execute the attestation where necessary, and attach an explanation and supporting identity documentation to avoid acquirer rejection.
Which file formats should I keep?
Store signed PDFs as the canonical record; retain source DOCX or XLSX files where changes may be needed, and export audit trails in a tamper-evident format for assessors.
How to retrieve an audit trail?
Use your eSignature platform's audit log export. Ensure logs include timestamps, IP addresses, signer email, and action history to satisfy assessor evidence requirements.

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