HomeMy WebLinkAboutMisc Letters BUILDING &CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
• 772-462-1553
,- t FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie CountyP n
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 Number. - �,•�. -- -���-
Expiration Date _ Zip Code
3 digit security code
Amount $ + 1.5% surcharge
Business Name: W 1 Stc-n e 1
Authorized Signature:
Print Name:
Phone: ( ti" ".`
Fax:
Comments:
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SLCPDSD Revised 4/01/2010 EN
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