Merchant Category Code application

To be completed by Partner:

Partner name:

Date of request:

Principal contact of Partner:

Name:

Title:

Email:

Phone number:

This request is for:

□ New MCC(s)

□ MCC change(s)

□ MCC deletions(s)

For each request for a new MCC, please provide:

For each request for an MCC change and/or MCC

deletion, please provide:

Description of industry or merchant category:

Annual sales volume:

Anticipated first use (month and year):

MCC(s):

Reasons for change/deletion: