PCI Scoping Form

Full Name*

First NameLast Name
Company Name*
Website*
Email*
example@example.com
Title*
How did you hear about us?*
PCI Service(s) Needed*

PCI Advisory/Readiness AssistanceAssisted Self-Assessment Questionnaire (SAQ)Report on Compliance (ROC)Not Sure
If you need to complete a Self-Assessment Questionnaire, what is your SAQ type?*
Click Here for More Information regarding SAQ

X
PCI Classification*

Service ProviderMerchantNot Sure
Number of annual credit/debit transactions*
Previous PCI Initiatives:*
Desired PCI Attestation Date*

ASAP/Within 30 daysWithin 90 daysWithin 6 monthsWithin 12 monthsTBD/UnknownOther
Where are you required to demonstrate PCI compliance (Regions where you operate) – please check any of these that apply*

USA (US)CanadaLatin America/Caribbean (LAC)Asia Pacific (APAC)Central/Eastern European, Middle East, Africa (CEMEA)TBD/ Not Sure
Do any of the following apply to your Company – please check any of these that apply*

My Company Stores/Processes/Transmits cardholder account dataMy Company could impact the security of other Customers’ account dataMy Company owns or manages on-premise systems and servers that touch credit/debit cardsAll of my Company’s cardholder data functions are outsourced to a PCI-compliant external providerMy Company has no cardholder data systems/networks managed on premise (PCI environment is fully collocated to a cloud provider)All cardholder data stored/processed/transmitted on systems managed by my Company is truncated, hashed, or tokenized (no full or unencrypted credit/debit card account number storage or processing)My Company develops custom software that provides payment functionsMy Company issues payment cards or virtual cards
PCI Scope/Environment – please check any of these that apply*

My Company accepts credit/debit cards in-personMy Company accepts credit/debit cards over the phoneMy Company accepts credit/debit cards onlineIf payment pages are present: payment page(s) redirect or use an iFrame connected to a compliant payment providerIf payment pages are present: payment pages accept credit cards via a form provided by a third partyMy Company operates a Call Center/Contact Center that processes credit/debit cardsMy Company uses or manages Point-of-Sale/Point-of-Interaction payment devices or systems
Please provide a brief description of your PCI Environment (how does your Company store, process, transmit, or impact the security of cardholder data)*
Does your organization use an automated GRC platform to track PCI compliance*
If you use a GRC platform to manage your PCI compliance what is your current PCI compliance percentage*
Are you a current Johanson Group Client?*

YesNo
Do you need a hand with any other Johanson Group services – please check any that apply

Penetration Testing (required for most PCI assessments)ASV/external vulnerability scanning (required for most PCI assessments)Policy/documentation development assistanceSOC 1/2/3 ServicesISO/IEC 27001 Certification ServicesISO/IEC 27017/27018 Certification ServicesISO/IEC 42001 ComplianceHIPAA AttestationCCPA/PrivacyGDPR/PrivacyNIST AssessmentTax/AuditNope, I’m good!
Please verify that you are human*
Owner ID
Should be Empty: