Surcharge Intake Form

This form collects the details we need to review your surcharge request and start the registration process. Please complete every section as incomplete submissions will delay your timeline. Once we receive your responses, our compliance team will review and follow up within 3 business days.

Fields

• Name*
• Email*
• Partner Account ID*
• Moov account ID
• Customer Account ID*
• Merchant's Moov account ID
• Surcharge start date*
  When do you plan to start surcharging?
• Planned surcharge rate*
  This cannot exceed your cost of acceptance for credit cards or the applicable network cap.
• Surcharging location*
  Surcharging is prohibited or restricted in certain U.S. states. It is your responsibility to verify that surcharging is legal in every state where you operate.
• Signage and receipt plan*
  Describe how you'll notify customers about the surcharge. Merchants are required to post signage at the point of entry and point of sale, and to show the surcharge as a separate, clearly labeled line item on every receipt.
• Refund procedures*
  How will you handle surcharges when a transaction is refunded? The surcharge amount must be included in the refund.

Submit

Please fill out all required fields.