File a Claim Online

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Step 1 of 4 · Business

All fields are required unless marked optional. Filing is free.

1. Business information

Merchant legal business name

Doing-business-as (DBA) name (optional)

Business type (MCC code)

Type of business

Mailing addressStreet address only. No P.O. boxes.

City

State

ZIP code

Business phone

Business email

Business website (optional)

Total number of locations