HomeMy WebLinkAboutsubcontractor change acBUILDING & CODE REGULATION DIVISION
J, 2300 VIRGINIA AVENUE
• FORT PIERCE, FL 34982
• 772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE: S ('� l/on �'�lU�'
Permit # � Coco Uc'I I
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 Number q g Da -7 EUU 001 .)" �; aa,
Expiration Date S / � Zip Code
3 digit security code U U'
Amount $ SD + 1.5% surcharge
Business Name:
Authorized Signature: -<' /�'—
Print Name: s�CA S A(LL
Phone:
Fax: ( -
Comments:
SLCPDSD Revised 4/O1/2010 EN