Arizona State Agency Websites Made Easy

Stand-alone Payment Website Request

Please complete the below information and we will contact you regarding building your stand-alone payment website. Currently ADOA-ASET does not charge for this service to connect to the web portal payment processing system. However, there are limitations to how this service can be used. Once you have completed the form below, we will schedule a consultation to review your requirements and discuss the limitations of this service. When completing the fields below, it may help to view an existing payment website such as: https://adcpay.az.gov/

Contacts

Primary Contact Name *

Primary Contact Agency *

Primary Contact E-mail *

Primary Contact Phone *

Basic Information

What types of "products" will you sell on this site? *

Will the customer buy one product at a time or a combination of multiple products? *

Customers will only be purchasing one product at a time.

Customers may purchase a combination of different products in a single transaction.

What will be the anticipated transaction volume per year? *

Please provide a rough estimate of the current # of transactions you anticipate receiving each year.

What will be the anticipated transaction value per year? *

$

Please provide a rough estimate of the total dollar amount you will collect in a year.

What Domain Name would you like to use for the payment website?

https://.az.gov

Your stand-alone payment website will be hosted as a sub-domain of AZ.gov. The domain name can be specific to your agency, or specific to the types of products you will sell. For example: ADCPAY.az.gov or DPSrecords.az.gov

Site E-mail Address:

What email address should be used as the "From" address when the site sends emails?

Is there a logo or graphic that you would like used on the site?

If no graphic or agency logo is provided, the State seal will be used by default.
More information

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

What data do you want to collect from the user?

For example, Name, Address, Invoice #? Example fields have been provided for your convenience.

Languages Needed

Please list each language, other than English, that you want to be made available to your users. You will need to provide all translated content for each of the messages below.

Messages

Site Slogan:

This field is optional. The Site Slogan is text that appears in the header of the website, underneath the Agency Name.

Welcome Message:

Please provide a welcome message to display to the user when they first reach the site. An example message has been provided for your convenience.

Confirmation Message:

Please provide a confirmation message to display to the user after they have made their payment. An example message has been provided for your convenience.

Notification E-mail Address:

What email address(es) should be used to send submissions to? Typically it is best for this to be a distribution list managed by the agency.

Agency Notification Message:

What should the email say that is sent to the agency contacts after a payment is made? An example message has been provided for your convenience.

Customer Notification Message:

Message: What should the email say that is sent to the agency contacts after a payment is made? An example message has been provided for your convenience.

Users

Business Users

Please provide the names and email addresses of those who should be able to log into the site to conduct the following activities: Business Review - Review order submission reports. Make content changes. Please separate each E-mail with a comma.

Financial Users

Please provide the names and email addresses of those who should be able to log into the site to conduct the following activities: Financial - Review order submissions and payment status reports. Submit CASH payment transactions if requested. Please separate each E-mail with a comma.

Additional Information

Please provide any additional information or comments you would like us to know to develop your stand alone payment application.

Additional Documentation

Please upload any additional documentation or information that will help us build your payment site.
More information

Files must be less than 100 MB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit zip.

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Stand-alone Payment Website Request

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