Please submit the information requested below. MasterCard will evaluate this information and will only respond to legitimate inquiries, as determined by MasterCard in its sole discretion. Please be advised that responses may take up to 2 weeks.

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Merchant Name

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Merchant Category

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AirlinesCar RentalClothing StoreDepartment StoreDiscount StoreDrug StoresDrug StoresGrocery Store Gas StationHardware StoreHealthcare Hotel/MotelFurniture StoresMail OrderOther Retail Other ServicesProfessional ServicesRestaurants/Bar Sporting Goods Travel AgenciesUtilitiesCar Dealerships Other

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Affiliated Merchants/Stores

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Current MasterCard acquirer/card acceptance service provider

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Annual MasterCard sales volume

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Contact Name

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Title

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Email

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Address line 1

Address line 2

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City

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Province

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Postal Code
(e.g.: Y1Y<space>1Y1)

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Phone Number
(e.g.: 8005555555)

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