b Payment Types for GPISF Assessment (not all payment types are supported for all programs) (check all that apply, but only if Merchant elects GPISF assessment): Credit (check all that apply): Visa - Eligible MCCs: 8211, 8220, 8244, 8249, 9211, – 9222, 9311, 9399 MasterCard - Eligible MCCs: 8211, 8220, 8299, 9211, 9222, 9223, 9311, 9399, 9402 Discover (available if Elavon-acquired) Signature Debit (check all that apply): Visa - Eligible MCCs: 8211, 8220, 8244, 8249, 9211 – 9222, 9311, 9399 MasterCard - Eligible MCCs: 8211, 8220, 8299, Government/Public 9211, 9222, 9223, 9311, 9399, 9402 Institution Service Discover (available if Elavon-acquired) Fees (continued) Elavon Product Supporting GPISF Assessment to be Used by Merchant (check all that apply): Biller Direct Services (not available to State Agency Authorized Users; Non-State Agency Authorized Users may contract for such services with KMS/Elavon directly SEPARATE Schedule – K required) (check one option below, but only if Merchant elects Biller Direct Services) Bill Payment Portal Enterprise Billing Solutions Service Fee Terminal (VeriFone vx520 or equivalent) Merchant Proprietary Solution or Value-Added Servicer Other _______________________________________ c Converge Services Converge Services Converge Tokenization Services
b Government/Public Institution Service Fees (continued) Payment Types for GPISF Assessment (not all payment types are supported for all programs) (check all that apply, but only if Merchant elects GPISF assessment): Credit – (check all that apply): Visa - Eligible MCCs: 8211, 8220, 8244, 8249, 9211, 9222, 9311, 9399 MasterCard - Eligible MCCs: 8211, 8220, 8299, 9211, 9222, 9223, 9311, 9399, 9402 Discover (available if Elavon-acquired) Signature Debit – (check all that apply): Visa - Eligible MCCs: 8211, 8220, 8244, 8249, 9211 9222, 9311, 9399 MasterCard - Eligible MCCs: 8211, 8220, 8299, 9211, 9222, 9223, 9311, 9399, 9402 Discover (available if Elavon-acquired) Elavon Product Supporting GPISF Assessment to be Used by Merchant (check all that apply): Biller Direct Services (not available to State Agency Authorized Users; Non-State Agency Authorized Users may contract for such services with KMS/Elavon directly – SEPARATE Schedule K required) (check one option below, but only if Merchant elects Biller Direct Services) Bill Payment Portal Enterprise Billing Solutions Service Fee Terminal (VeriFone vx520 or equivalent) Merchant Proprietary Solution or Value-Added Servicer Other _______________________________________ c Converge Services Converge Services Converge Tokenization Services
7900822419form2_KMS.docx