Credit Card use in Rome, Florence, and smaller towns in Tuscany.

Visa and Mastercard are accepted everywhere.
Amex not so much.

Simon,

I've found that some shops in smaller towns may prefer cash, especially for small purchases. I use both M/C and Visa, and have never had any issues with either of those.

They may prefer cash payments, but it doesn't mean you can't pay with card.
Visa and Mastercard are accepted everywhere

I agree with Ken. We used cash to buy pizza and a beer (cheaper than soda) for a quick lunch in San Gimignano. We collect small pieces of original art on our trips and try to pay the artist with cash. With every trip to Europe, including one last December, we take less and less cash. We needed more cash than we had in Salzburg and I just went to a local ATM and made a withdrawal. You can select English to guide you through the prompts.

One more note - since lockdown tapping your credit card has become the preferred way to use them. A couple of years ago I had to switch from my primary card to my back-up card because one had tap and the other didn't.
Europeans use chip and pin when they don't use tap and the different American system of chip and signature adds to their confusion so tapping makes everything much easier. You may still be asked to sign a credit card slip for larger purposes.

Have a great trip,
=Tod

Thanks for the quick responses everyone. I’m Canadian so we also use primarily tap with chip and PIN for only big purchases. Chip and signature (traveling to the US) baffles me.
Simon

Accepting digital payments is mandatory, but definitely get some hard cash at a bank ATM when you get there for the small purchases. In rural Italy a glass of Prosecco at a bar might cost you 2 euro, and an espresso just above 1 euro. For those purchases I use euro coins and bills. When you pull out money at an ATM make one large withdrawal rather than multiple small ones. Some banks, like Chase, charges $5 per withdrawal at ATM overseas, so minimize the number of withdrawals.

To get cash from an ATM, a Schwab checking account with a debit card is a good thing to have. It's easy to open. When you use it overseas there are no transaction fees and if you do get charged by the ATM bank, Charles Schwab reimburses you. You don't have to be a stock buyer. It was reccomended to me on this site 2 years ago. It is also a Visa.

Visited all three locations and used Visa and Mastercard with no problems. Tap and pay is very common.

I didn’t try my Amex because the forex is not free on my card.

We had some cash for small purchases and used that at small shops, gelato, snacks, etc and that was helpful but not essential.