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N the requirements included in the PCI Data Security Standard. For any questions where N/A is marked, a brief explanation should be attached. Questionnaire Reporting The following must be included with the self-assessment questionnaire and system perimeter scan results: Organization Information Corporate Name: DBA(s): Contact Name: Title: Phone: E-mail: Approximate number of transactions/accounts handled per year: Please include a brief description of your business. Please explain your.

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