Form

First name*

Last name*

Mobile phone number*

Email*

Company name*

Surcharge %*

This must bear a reasonable relationship to your cost of acceptance

I confirm that by filling this form out that I am authorized on the account to make changes and that surcharging will be added to my terminal at an additional cost of $10 + GST per month

I confirm that I have read and understood my obligations as a merchant surrounding surcharging. The information can be found here: https://hubs.la/Q01fYnWN0