Payment Processing Fee Audit Form
Payment Processing Fee Audit Form
Business or Merchant Name
*
Business Identifier (e.g., partial account ID, merchant reference)
*
Payment Processor or Platform
*
Please Select
Stripe
Square
PayPal
Adyen
Worldpay
Other
Statement or Audit Period
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Total Transaction Volume (for the period)
*
Total Transaction Amount (for the period)
*
Fee Categories Reviewed
*
Processing Fees
Refund Fees
Chargeback Fees
Monthly Fees
Other
Describe Any Fee Discrepancies or Issues Identified
*
Upload Supporting Documentation (e.g., statements, reports)
Upload a File
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Choose a file
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of
Contact Name and Email for Follow-Up
*
Submit Audit
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