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Square Card Reader Request Form
SECC Region (Select one from the menu)
- None -
Amarillo
Brazos Valley
Capital Area
Coastal Bend
DFW Metroplex
East Texas
El Paso
Galveston
Greater West Texas
Houston
Laredo
North Texas
Rio Grande Valley
San Antonio
South Plains
Texas Pine Belt
Waco
SECC Square Card Reader Policy
I have read the
SECC Square Card Reader Policy
, will abide by the requirements set-out in this policy and agree to return a signed copy of it to my Local Campaign Manager, prior to my being allowed to use a Square device(s).
*IMPORTANT*
1. Please review the
Square Card Reader Process overview
before proceeding with this request.
2. Complete the request form below to reserve a Square Card Reader.
3. Complete a pledge form for each special event (including event name, total amount raised, charity undesignation or charity code designation). Download a pledge form here:
Resources | Texas State Employee Charitable Campaign (secctexas.org)
4. Submit completed pledge form and return the Square device to your SECC Local Campaign Manager.
Date and Time(s) of Event(s)
Date the Square card reader will be returned to LCM
Employee Name
State Agency, College or University Name
Shipping Address
Address
Address 2
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
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Delaware
District of Columbia
Federated States of Micronesia
Florida
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Hawaii
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Indiana
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Louisiana
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Marshall Islands
Maryland
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New York
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Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Event(s) where the Square card reader will be used? Please describe.
Contact Email
Contact Phone
What kind of device are you using?
- None -
Android
iPhone (Lightning port)
iPhone (USB-C port)
Submit