HomeMy WebLinkAboutAUTH FOR CC PAYMENT06/10/2011 09:14 772466a7
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SEACOAST AC
SLC INSPECTIONS
PAGE 01
PAGQ 9i/ai
BUILDING & CODE REGULATION DIVISION
2M VIRGINIA AVENUE I �i
PORT PIERCE, FL 34982
772-487.-1SS3
FAX 772 40 __. _ Q tea`
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE:
sowGv
It IB4
Permit*
Credit Card Users; 4 i SUA: ft,* added per lra cldFo�. .
Payments must be received in'thIsdepartment by 4:00 PM for transaction to be
procceessed that day, if not It wig be processed the following bustness day.
V VISAo MASTERCARD
Credo Card Numb
Fxpiratlon Date �p Code 3u(ILRP
3 digit security code • • . .
'Amount $ + 4% surcharge
ousiness Warpe'. �
AutPorizpd Signature'
A1nt•IVame:'
• Phone: �, ••�.
Comments. '
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