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Fill out the form below and a representative will be in contact within 1 business day of submission.

Contact Information

You must enter a contact name.
You must enter a DBA name.
You must enter a contact number.
You must enter a business phone.
Please enter a valid Email address
Business Address

You must include a Street.
You must enter a city.
You must enter a Zip.
Surcharge Information

You must select a surcharge type.
You must enter a number.
You must select a channel.
By clicking, “I Agree” Merchant acknowledges that they have read the rules associated with Surcharging and agrees to accept responsibility for being in compliance with said rules.