HomeMy WebLinkAboutAuthorization Form for Credit Card PaymentBUILDING & CODE REGULATION DIVISION
2300 VIRGINIA.AVENUE
FORT PIERCE, FL 34982 O- W--
772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
Permit # 6—
Credit Card Users: 1,5016 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.
":x .:.;; VISA
Credit Card Number.:_� 0
Expiration Date Frdy.;W Zip Code :
3 digit security code tf 09 WIR :Nal
Amount 5 .xs i'.2,, + 1.5% surcharge
Business Nan
Authorized Si
Print Name:
Phone:
Fax:.
Comments:
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