HomeMy WebLinkAboutAuthorization Form for Credit Card PaymentBUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34.982
772-462-ISS3
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE,.,
Permit # ^.
Credit Card Users: 1,5% Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA
MASTERCARD
Credit Card
Expiration Date =z j-" Zip Code 7F,� 7 •<
3 digit security code
Amount . ti z :.s,7 + 1.5% surcharge
Business Nan
Authorized Si
Print Name:
Phone:
Fax:
Comments:
65 K .., e..F
SLCPDSD Revised 4/O1/2010 EN