EMV Attestation

This page serves as a PCI Acknowledgement and Attestation. Please use the directions below as a starting point for the agreement. The attestation describes that you will have a Security Policy and Incident Response Plan – both are included here.

Section 1

  • Enter your pharmacy name in the “Name” field.
  • Enter an email which you can access easily.
    (This will be used in Section 2.)
  • Click Proceed To Document to continue to step two.

Section 2

  • Follow the steps below to sign your document.
  • Check your email to confirm your signature.
  • After confirming your signature, check your email once more to review and download your signed document.