PCI Security Standards Council®

Qualified Integrators and Resellers

Organizations qualified by PCI SSC as Qualified Integrator and Reseller Companies (QIR Companies) are authorized to implement, configure, and/or support validated PA-DSS Payment Applications on behalf of merchants or service providers for purposes of performing Qualified Installations as part of the QIR Program. The quality, reliability, and consistency of a QIR Company’s work provide confidence that the Payment System has been implemented in a secure manner.


This form is used to review QIRs and their work product and is intended to be completed by the QIR customer after an installation. The primary audience of this form is QIR customers (merchants or service providers).

Fields marked * are required.

Customer (merchant or service provider) Qualified Integrator and Reseller (QIR)
Customer Company Name * QIR Professional Name *
Customer Contact Name * QIR Company (if applicable)
Customer Contact Title QIR Company Contact Name
Customer Contact Telephone *    
Customer Contact Email *    
Location of Service  
Street *    
City *    
State/Province *    
Country *    
Postal Code *    
For each question, please indicate the response that best reflects your experience and provide comments.
5 = Strongly Agree     4 = Agree      3=Neutral       2 = Disagree      1 = Strongly Disagree




1. During the initial engagement, the QIR explained the objectives and review process and addressed your questions and concerns.

2. The QIR employee(s) demonstrated sufficient security and technical skills to effectively perform this installation.

3. The QIR avoided conflicts of interest such as requiring brands of products and services to achieve a qualified installation.

4. The QIR provided me with a clear explanation of security controls related to remote access, account passwords and patching.

5. There was sufficient opportunity to ask questions and solicit responses.

6. During the installation wrap-up, the QIR provided me with a copy of the QIR Implementation Statement and clearly communicated the status and/or any comments or outstanding issues.

Please provide any additional comments here.

Our website uses both essential and non-essential cookies to analyze use of our products and services. This agreement applies to non-essential cookies only. By accepting, you are agreeing to third parties receiving information about your usage and activities. If you choose to decline this agreement, we will continue to use essential cookies for the operation of the website. View Policy