If your business accepted Visa or MasterCard payments anytime from January 1, 2004 to January 25, 2019, you may have a pending Settlement.  Once you fill out this form, you will receive an email with CCS Retainer Agreement to sign, at the time you engage CCS we will assure you that your Claim will be processed on time with the Claims Administrator.

Instructions for Completing this Online Form:

 1. Submit one registration form per Employer Identification Number (EIN). If you had multiple EINs during the filing period of 2004-January 2019, please submit a separate registration form for each EIN.

 2. If you have multiple locations operating under a single EIN, please submit only one form for that EIN.

 3. Ensure that the EIN you are filing for is the EIN associated with your Merchant Account(s) for the period of 2004-January 2019.

 4. If you have multiple locations under one EIN, submit only one form for that EIN.

 5. Ensure that the person selected to sign the form is an Authorized Officer of the entity.

 6. Verify that your EIN contains 9 digits. 


Please submit an individual form per each Tax Payer.