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Merchant Surcharge Disclosure Form
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Type Of Surcharge
Please select
Brand
Product
Please select a type of Surcharge
*
# of locations surcharging
Please select
1-50
51-100
101-500
501-1,000
1,001-2,500
2,501-5,000
5,001+
Please select surcharging
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If you have problems submitting this form, please email
merchant_surcharge_notification@mastercard.com
with the information contained in the form.
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