PCI DSS Readiness Assessment Proposal

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PCI DSS Pre-Assessment Services Proposal

PCI DSS Pre-Assessment Services Proposal

General Information

Please provide us some basic information

1. Organization Name *

This field is required!

2. Name *

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3. Title *

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4. Email *

Enter valid Email

5. Phone *

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Phone Number format should be in (eg: 585.313.2336)

6. Website *

Enter valid domain

7. Address *

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8. City *

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9. State *

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10. Zip *

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11. Country *

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12. Time frame for project
Next 30 days
Next 3 months
Next 6 months

13. Has the Assessment been budgeted?
Yes
No
Not Sure

14. Is there a date the project must be completed by?

Business Information

General information

15. What sector is your business in?*

16. Have you identified and documented all locations and flows of cardholder data, as well as identified and documented all systems that are connected to or, if compromised, could impact the CDE (Cardholder Data Environment) (for example, authentication servers)?*
Yes
No
Not Sure

17. What is the date of previous ROC (Report on Compliance) or SAQ (Self Assessment Questionnaire), which ever is applicable?

18. Have PCI DSS policies been reviewed, updated in past 12 months?
Yes
No
Not Sure

19. Are you a Merchant, Issuer, or Service Provider?*
Merchant
Issuer
Service Provider