Establishing secure connection…Loading editor…Preparing document…

PCI Compliance Document

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

PCI Compliance Document

This PCI Compliance Document (the "Agreement") is entered into between the undersigned parties as of the Effective Date.

Effective Date:

Client Name:    Client Contact:

Service Provider Name:    Provider Contact:

RECITALS

WHEREAS, Service Provider is engaged in the business of performing Payment Card Industry Data Security Standard (PCI DSS) assessments, remediation planning and attestations for entities that store, process or transmit cardholder data; and

WHEREAS, Client operates systems and/or services that store, process or transmit cardholder data and desires to retain Service Provider to perform PCI compliance services and to provide written attestations or reports of compliance where applicable; and

NOW, THEREFORE, in consideration of the mutual covenants set forth below, the parties agree as follows.

SCOPE OF WORK

Deliverables shall include, at a minimum, a written assessment report describing findings, a remediation plan for identified deficiencies, and, if applicable, an attestation of compliance signed by an authorized representative of Service Provider.

PAYMENT TERMS

Late Payment: Client shall pay interest on overdue amounts at a rate of per month, or the maximum rate permitted by law, whichever is lower. Client is also responsible for reasonable collection costs, including attorney fees.

TERM AND TERMINATION

Term Commencement Date: . Term End Date:

Either party may terminate this Agreement for convenience upon written notice to the other party delivered at least days prior to the effective termination date. Either party may terminate immediately for material breach if the breaching party fails to cure such breach within thirty (30) days after receipt of written notice specifying the breach.

Termination shall not relieve Client of the obligation to pay for services rendered and expenses incurred through the effective date of termination.

CONFIDENTIALITY

Each party acknowledges that in the course of performance it may receive or have access to Confidential Information of the other party. "Confidential Information" includes, without limitation, cardholder data, assessment findings, security architecture, remediation plans, and any non-public business information. Each party shall: (a) use Confidential Information solely for performance under this Agreement; (b) restrict disclosure to employees, contractors or agents with a need to know and who are bound by confidentiality obligations at least as protective as those herein; and (c) implement and maintain appropriate administrative, technical and physical safeguards to protect Confidential Information from unauthorized access, use or disclosure.

Notwithstanding the foregoing, Confidential Information does not include information that is or becomes generally known to the public other than as a result of a breach of this Agreement, or is independently developed by the receiving party without use of the disclosing party’s Confidential Information. In the event of an actual or reasonably suspected breach affecting cardholder data, Service Provider shall notify Client promptly and cooperate in incident response and regulatory reporting as required.

ATTESTATION AND CERTIFICATIONS

Service Provider certifies that the assessment and any attestation will be conducted in accordance with applicable PCI DSS requirements and recognized industry assessment methodologies. Service Provider's attestation is based upon the representations and cooperation of Client and the accuracy of information provided by Client. Service Provider makes no guarantee that Client will achieve or maintain PCI compliance or that any payment card brand or acquiring bank will accept the attestation.

Service Provider attests that, to the best of its knowledge at the time of issuance, the assessment findings are accurate and complete: I attest.

LIMITATIONS; WARRANTIES

Service Provider warrants that services will be performed with reasonable care and in a professional manner consistent with industry standards. Except as expressly set forth in this Agreement, neither party makes any other warranties, express or implied, including any warranty of merchantability or fitness for a particular purpose.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of law principles. The parties submit to the exclusive jurisdiction of state and federal courts located in that state for any disputes arising out of this Agreement.

INDEMNIFICATION

Each party shall indemnify, defend and hold harmless the other party and its officers, directors and employees from and against any third-party claims arising from the indemnifying party's gross negligence, willful misconduct or material breach of this Agreement. In the event of a data breach attributable to the negligence of Service Provider, Service Provider's indemnity obligations shall include reasonable costs of forensic investigation, notification and mitigation to the extent caused by Service Provider's acts or omissions.

ENTIRE AGREEMENT

This Agreement, together with any statements of work or exhibits expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements, proposals and communications, whether written or oral. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

MISCELLANEOUS

If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect. Neither party may assign this Agreement without the other's prior written consent, except that Service Provider may assign to an affiliate or successor in interest.

Client Printed Name:

By:

Date:

Service Provider Printed Name:

By:

Date:

Enter text✕

What the PCI Compliance Document Is and When It’s Used

The PCI Compliance Document is a formal record that demonstrates an organization’s adherence to the Payment Card Industry Data Security Standard (PCI DSS) requirements for handling cardholder data. It typically consolidates policies, technical controls, scan and testing results, remediation actions, and attestations of compliance. Organizations use this document to satisfy merchant bank, acquiring bank, and card brand due diligence, to support audits, and to guide internal security practices. The document is often updated after assessments, significant system changes, or remediation and serves as both evidence and a procedural reference for security teams.

Why Maintaining a PCI Compliance Document Helps

Maintaining a PCI Compliance Document centralizes proof of controls, reduces audit friction, and supports risk management. It clarifies responsibilities, documents remediation timelines, and provides acquiring banks and card brands with the evidence needed to assess compliance posture during reviews.

Why Maintaining a PCI Compliance Document Helps

Who Prepares and Relies on the PCI Compliance Document

Organizations across payments, IT, and compliance teams prepare or maintain the PCI Compliance Document as part of ongoing cardholder data protection efforts.

  • Merchants and e-commerce businesses responsible for card acceptance and transaction processing.
  • Third-party service providers that store, transmit, or process cardholder data on behalf of merchants.
  • Internal security, IT, and compliance teams preparing for assessments, scans, and remediation tracking.

Smaller merchants may rely on qualified assessors or managed service providers to assemble and validate the document.

Core Sections a Professional PCI Compliance Document Should Contain

A complete document combines policy statements, technical evidence, scans, remediation records, roles and responsibilities, and attestation statements tailored to the assessed environment.

Executive Summary

Summarize scope, assessment level, systems in scope, high-level findings, residual risks, remediation status, and the overall compliance determination to orient auditors and stakeholders and recommended next steps.

Scope and Inventory

List in-scope networks, applications, payment channels, and inventory of systems and service providers with cardholder data access. Include segmentation and scope reduction decisions and responsible owners.

Technical Evidence

Include scan reports, penetration test results, logs, configuration baselines, and change records. Attach dates, tool versions, remediation tickets linking findings to closure evidence and signatures.

Policies & Procedures

Document written policies for cardholder data handling, access control, incident response, encryption, and vendor management. Reference review cycles, approval authorities, and training records with revision history.

Attestation

Include signed attestation of compliance (AOC) or assessor report, scope confirmation, and executive sign-off. Record the assessor name, qualification, the date of assessment, and contact details.

Remediation Log

Track findings, assigned owners, target and completion dates, verification steps, and evidence attachments. Highlight open high-risk items and record compensating controls with status history.

Required Data Elements to Include

Cardholder Data Scope: Systems, channels, and storage locations.
Assessment Type: SAQ, ROC, or ASV scan.
Assessment Dates: Assessment and evidence dates.
Assessor Identity: Qualified assessor or internal team.
Remediation Status: Open, in progress, verified closed.
Logs & Reports: Scan outputs, pen tests, and logs.

Step-by-Step: Preparing the PCI Compliance Document

Follow a repeatable sequence to define scope, gather evidence, document controls, remediate findings, and finalize attestation for auditors and stakeholders.

  • 01
    Define scope: Identify in-scope systems and payment channels.
  • 02
    Collect evidence: Retrieve scan reports, logs, and configs.
  • 03
    Remediate findings: Assign owners and track remediation tickets.
  • 04
    Finalize attestation: Draft AOC and obtain authorized signatures.

Customize and Complete the PCI Compliance Document Online

Configure an online workflow to collect signatures, attach evidence, enforce required fields, and route the completed document to auditors or banks.

Field Name and Configuration Settings How to set each field in the online workflow.
Primary Signer Signature Field (required) Make visible, require date, allow guest signing.
Evidence Attachment Field (PDF upload) Allow multiple attachments, enforce file types, set size limits.
Conditional Fields Based on Scope Show fields only when relevant for selected payment channels.
Routing Rules and Email Notifications Route to internal reviewers, external auditors, or acquiring bank contacts.

Where to File, Send, or Submit the PCI Compliance Document

Determine recipients and filing destinations based on contractual obligations, bank requirements, and regulatory reporting needs before finalizing distribution.

  • Acquiring Bank: Submit to acquiring bank as required by contract or remediation request.
  • Card Brands: Provide AOC or ROC copies to card brands when requested during reviews.
  • Internal Audit: Store final document in governance repository and notify internal auditors.
  • Regulators: Share specific evidence with regulators only when legally required or under subpoena.

Distribution Methods and Platform Requirements

Choose platforms that support secure sharing, audit trails, required authentication, and encryption to meet PCI DSS evidence standards.

  • File Formats: PDF/A, DOCX, and raw logs accepted.
  • Integrations: Salesforce, NetSuite, Google Workspace, and Box.
  • Security Controls: TLS 1.2 and 1.3 in transit; AES-256 at rest.

Timelines, Deadlines, and Processing Expectations

Track assessment windows, remediation SLAs, and reporting deadlines so evidence remains current and acceptable to banks and card brands.

Assessment Frequency and Window:

Annual ROC or quarterly ASV scans, plus after material system changes or major incidents.

Remediation SLA Expectations:

Assign remediation targets; typical SLA is 30 to 90 days based on severity.

Evidence Freshness:

Provide scans and test results dated within reporting window requested by bank or assessor.

Audit Response Time:

Allow at least seven to fourteen business days for reviewer inquiries.

Reassessment After Remediation:

Re-scan and re-test before final attestation to ensure controls are effective.

Common Mistakes When Preparing the PCI Compliance Document

  • Failing to scope correctly by excluding cloud services or third-party processors that handle cardholder data — leads to incomplete evidence and failed assessments.
  • Using outdated scan reports or pen tests; evidence older than the requested window can be rejected, triggering more testing and delays.
  • Mismatched entity names between contracts, bank records, and the document can prevent acceptance and may require notarized affidavits to reconcile.
  • Not tracking remediation status with verifiable closure evidence such as ticket IDs, test results, and validation dates increases audit risk.

Penalties and Risks of an Incorrect PCI Compliance Document

Failed Assessments: Remediation orders, fines, increased fees.
Card Brand Actions: Account suspension or termination.
Liability Exposure: Fraud costs and breach notifications.
Increased Fees: Higher transaction fees and reserves.
Reputational Harm: Customer loss and contract terminations.
Bank Relationship Risk: Loss of acquiring bank support.

eSignature Pricing and Feature Comparison for PCI Workflows

Compare baseline pricing and key feature availability across leading eSignature vendors to estimate platform cost and compliance fit for PCI evidence workflows.

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 vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes Yes
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No envelope cap 100 envelopes/user/year limit Varies by plan Varies by plan Varies by plan

Frequently Asked Questions About the PCI Compliance Document

Answers to common questions on scope, signatures, evidence, and platform features to help prepare an accurate PCI Compliance Document.


Need help? Contact support

be ready to get more
Join over 28 million airSlate SignNow users