x|&2��2{�������*�uV�2���?껋*����"�H�j����~��������(fo�zv�����3��a~��}v6?2��y6����_>x ��(M^�.�go�Grv��T��w�r���g�j��KJ��*�urNh�g�/�G5�H�N�ω�S��fg�(� Attach this form to your document or written request. Box 369 380 A Avenue Certified Paper Copy - $5.00 certification fee Date” along with the three-digit CVV code associated with your credit card (usually located on the signature area on the back of your Credit Card) on the blank line labeled “CVV.”, 6 – Demonstrate Your Intent To Authorize The Defined Payment Information, In order to provide proof of your approval, the Acknowledgement Statement presented should be completed. I, , give Mecklenburg County Revenue Collection Department permission to charge $ , To my (Visa/MC/Discover) for payment of estimated upfront fees for Project # . This can either be for a 1-time charge or recurring (weekly, monthly, etc). Make sure to have your account information handy when filling out this form as this will need to be presented accurately. When faxing, mailing, or e-mailing, please use the Credit Card Form below. City of Lake Oswego. Co-pays, co-insurance, and out of pocket fees are due at each session. City of Sandy 39250 Pioneer Blvd. Payment can be made by credit card using this Credit Card Authorization Form. Use the blank space below the Street Address you just entered to record the City, State, and Zip Code listed associated with Account Holder’s Billing Address on the space labeled “City, State, Zip.” The Account Holder’s Phone Number and E-mail Address should both be recorded in this area. I certify that. 3 – Furnish Your Choice With The Requested Information, Now that we have solidified how often the authorized payment is allowed, we will need to disclose some basic facts regarding the parties and amounts involved. 1-Time ACH Authorization – Make a one (1) time payment via bank account (checking or savings) by providing the Account and Routing numbers. 5 – Detail The Method Of Payment Being Authorized. A credit card authorization form allows a 3rd party to make a payment by using a person’s written consent and credit card information. What is a Credit Card Authorization Form? If a business has a dispute ratio higher than the allowed rate, their payment processor will likely suspect their business to be practicing shady ethics. Credit Card Authorization . Resources. If you intend on approving the third party’s use of your “Checking” or Savings” account to make this payment, then you must mark the appropriate check box in the “Bank (ACH)” area. P.O. ). Our support agents are standing by to assist you. If the payment you are authorizing is a recurring payment, one that your account should pay automatically every billing cycle, then place a mark in the check box labeled “Recurring Charge.” If the payment you are authorizing should only be made once, and by virtue of this form, then check the box corresponding to “One (1) Time Charge.” Keep in mind this will mean that after this payment is made, the approved party will be unable to submit the same payment at any point in the future using this authorization. County Zoning Division to process a charge against my credit card account in the amount of $_____ for the payment of: Garage Sale Permit Fee ($14) (Community Garage Sale, .50 for each additional address) Temporary Off Site Signs ($4.50 each, limit six) ... Credit Card Authorization Form Created Date: Title: authorization-to-use-credit-card (37989 clicks) Caption: Filename: authorization-to-use-credit-card-2.pdf Size: 41 KB We hope that these forms are useful for you. If being used for a hotel room authorization the form may be signed by the cardholder and faxed to the lodging establishment. Second, it prevents unwanted and fraudulent chargebacks that can hurt the relationship between a business and a merchant processor. %PDF-1.5 4 0 obj If a business is getting too many chargebacks, their merchant provider may eventually cease to do business with them. Revision Credit Card Authorization Form; Revision Transmittal; Agriculture. ... Credit Card Authorization Form . © 2020 Electronic Forms LLC. This is a common procedure when an individual authorizes a subscription that renews on a monthly basis (such as gym memberships, monthly rent, etc.). :��LC�U��R1BSdpI&0��$����9����������A>_��㘹Y��^垳�$I���v��1lg"��sd�� �lH�J#&�:�f�����_����/��VU"Ѳ�k���Y"r�H��U�: 1-Time Credit Card Authorization – A general form for a charge that will be made for a single payment on a credit card. Name on Card: * The credit card listed below may be billed for the estimated charges Ten (10) days prior to event/reservation date. PLEASE DO NOT WRITE CREDIT CARD NUMBER ON THIS FORM PEOPLE PRIDE PROGRESS PARTNERSHIPS <>>> "��Jf�6y!���f����o>����z� {��$�:�! as the transaction corresponds to the terms indicated on my request. 1 – Open And Download The Authorization Template On This Page. Use the following instructions to charge a credit card or bank account by obtaining the customer’s credentials via a paper form. The authorization hold can range from $1 dollar all the way to the full amount depending on the situation. First, it gives a business the authority to charge a credit card without the buyer being physically present. You, as the Account Holder, must sign your Full Name on the blank space labeled “Bank Account/Cardholder’s Signature” Finally, enter the Calendar Date when you signed this form on the line labeled “Date.”. Part I I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long. This paperwork will handle the task of proving your intent to allow another person to use one of your accounts to pay a bill. ... Credit Card Authorization Form. A credit card authorization form allows a 3rd party to make a payment by using a person’s written consent and credit card information. If this information is not readily available then you should contact the Merchant to satisfy this statement. All rights reserved. The following information will be required by the processor: Enter whether the account will be charged on a one-time payment or will it be continuing on a recurring basis. A credit card authorization form serves 2 primary purposes that play a large and important role for businesses and merchants. stream Please fill out all the fields below. County of Sacramento 720 9th Street Sacramento, CA 95814 916-874-5522—Website www.saccourt.ca.gov Credit Card Authorization Form Please complete one form per case number CARD HOLDER INFORMATION Name on Card: Card Holder Billing Address: City: State: Billing Zip: … Credit/Debit Card Billing Authorization Form ElderCare of Alachua County/Senior Recreation Center 5701 NW 34th Blvd, Gainesville, FL 32653 Phone: 352.265.9040 Fax: 352.265.9041 Statement of Cardholder: Please review the conditions below and initial to acknowledge your understanding and acceptance of the statements below. Credit Card/Debit Card Authorization. 9����s-�xS$�7xǃf��5*��I����x����S�e4Q�E�P,������6/u���\���+\hH���.��T L��o��_�E9;�g�6�_sj��� �e���u�y�a�H|:ul*��ϑÓ�����3 ��i. Fax (email not accepted) this completed credit card authorization form to (805) 568-3247 or Visits to open branch locations are by appointment only.Click here for branch availability.. Click here for information about PPP Loans. Download and fill out the Credit Card Authorization to allow us to charge your credit card for your Permit Fees. The Credit Report Authorization Form is a document that is used to give permission to an individual or organization to perform a credit report only.This form provides broad language that allows a credit report to be generated for any type of legal reason in compliance with the Fair Credit Reporting Act (FCRA) (15 U.S.C. I authorize Clackamas County to charge the credit card indicated above for the permits I am applying for. Title: Note: This credit card authorization form will be kept on file for 60 days from date of service. A credit card authorization form is a document, signed by a cardholder, that grants a merchant permission to charge their credit card for a period of time as written in that document. Most businesses are allowed a dispute range of no more than 1%-3%. Clackamas County Circuit Court 807 Main Street Room 104 Oregon City, OR 97045; Recurring automatic free monthly payments may be scheduled with the court using a Visa, MasterCard, or Discover Card. Title: CREDIT CARD AUTHORIZATION FORM Author: elpga Last modified by: bob Created Date: 3/16/2013 8:05:00 PM Company: University of Dallas Other titles endobj You must authorize a definitive sum of money for payment. COUNTY F L OR I D A . Any business that sees high or unfair disputes, should adopt a credit card authorization form for customers to sign anytime they can. * Hotel reserves the right to refuse a credit card authorization as a valid method of payment for same day bookings or authorization To pay fees using a credit card, simply complete and sign this form and attach it to your application. %���� Airline Credit Card Authorization – For any person seeking to pay an airline ticket via paper form. Signature Date ... Drive, Plantation, FL. Credit Card Authorization The Merced County Clerk-Recorder’s Office accepts Discover, American Express, MasterCard and Visa for payment of fees. How to Fill-out a Credit Card Authorization Form. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account. The drive up at our Canby Branch is open. COUNTY OF DUPLIN BUILDING INSPECTIONS DEPARTMENT PO BOX 950, 209 SEMINARY STREET, KENANSVILLE, NC 28349 (910) 296-2124 FAX: (910) 296-2166 CREDIT CARD AUTHORIZATION With my signature below, I hereby authorize Duplin County to charge the permit fee to my credit card. The branch will re-open for in-person appointments on Monday, January 11th. Fees are subject to change without notice. <> The section labeled “Billing Information” will seek some basic information regarding the Account Holder. Locate the blank space that follows the dollar sign in the statement beginning with the words “I Understand That This Authorization…” Record the penalty amount the Account Holder must pay each time the charge is rejected due to insufficient funds on this space. I authorize Broward County to charge to my credit card account. Thus, begin by locating the check box you marked, then enter your First, Middle, and Last Name on the first blank space (labeled “Full Name”) in that statement. To approve a third party’s use of your Credit Card for this payment, supply your Name on the blank space labeled “Card Holder Name.” Next, report the Credit Card Number you wish the funds to be drawn from on the blank space labeled “Account Number.”  Finally, transcribe the Expiration Date on your Credit Card to the lines labeled “Exp. From there you can view your point balance, see pending points, and how many points have been redeemed. They can be paid by cash, credit card, or check. For instance, you can authorize the third party’s use on “Tuesday” every “Week” or on the “15th” of every “Month.” If you have selected “One (1) Time Charge,” then enter the Calendar Date you expect the third party to pay this charge on the blank line labeled “Date.”Give a detail of what the payment is being used for on the line labeled “Description Of Goods/Services.”, 4 – Produce The Billing Information Required By The Authorization Process. As the Account Holder, you must sign this document. The cardholder must sign the authorization form. This is a common practice that gas stations and hotels widely use to prevent fraud. Due to how easy it is to call a bank and report a false or fraudulent charge, there needs to be a way for merchants to minimize losses in order to protect their business. The Name of Corporation or Other Business Entity To Which This Service Request Applies is: Use the blank spaces labeled “Phone #” and “Email” to present this information. Use the PDF, Word, or ODT button corresponding to the preview image on this page to open this document then save it to your machine. We will begin with the line labeled “Billing Address.” Use this space to report the Account Holder’s Building Number, Street Name/Number, and Unit Number listed on the account being used to pay the above-named Merchant. Hotel Credit Card Authorization – For the use of a guest that is going to be using a third (3rd) party’s credit card in order to stay at a hotel. I authorize Clackamas County to charge the credit card indicated above for the permits I am applying for. Any disputed charges made in conjunction with this request, shall be made within 45 days from date of service. If you would like a different format, we would be happy to convert the form and provide the source file within 24 hours. Please be aware that our agents are not licensed attorneys and cannot address legal questions. 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Your point balance, see pending points, and how many points have been.. Please use the following credit card Authorization form charge that will be kept on file for 60 days from of! Fill out clackamas county credit card authorization form PDF credit card Authorization form serves 2 primary purposes that a! Full amount depending on the situation chargebacks that can hurt the relationship between a business a... Not readily available then you should contact the merchant to satisfy this statement is a common that! Spaces labeled “ Phone # ” and “ email ” to present this information not. – open and download the Authorization Template on this page Method of being! Payment can be paid by cash, credit card seeking to pay an airline via... 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08 Jan 2021

clackamas county credit card authorization form

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Finally, document the “Account Number” and “Routing Number” the bank assigned to the account you are authorizing payment from utilizing the next two blank lines in this box. Sandy, OR 97055 One Commerce Plaza, 99 Washington Ave. Albany, NY 12231-0001 www.dos.ny.gov. This is a common procedure when an individual authorizes a subscription that renews on a monthly basis (such as gym memberships, monthly rent, etc. NOTE: When sending the following credit card form, PLEASE DO NOT include this page of instruction. Even though businesses can dispute a chargeback, it still has a negative effect. 1 0 obj Call 713-274-6390 for fee verification and assistance filling out this form The fees for paper copies are as follows: Non-Certified Paper Copy - $1.00 per page. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Revised 10/1/18 25552 La Paz Road, Laguna Hills, CA 92653 Tel: (949) 586-6800 Fax: (949) 586-0382 www.ocar.org One Time Credit Card Payment Authorization Form Sign and complete this form to ®authorize the Orange County REALTORS to make a one By signing this form, you give us permission to debit your credit card for the amount indicated. Clackamas County; Why Lake Oswego? Next, on the space labeled “Merchant’s Name,” enter the Legal Name of the party that you will make the defined payment to. That is, place a mark in the check box labeled “Checking” or the check box labeled “Savings.”  You will also need to supply the Full Name of the Account Holder on the blank line labeled “Name On Account.” Next, present the Name of the Bank where your account is held on the “Bank Name” line. Credit Card Number: NYS Department of State DIVISION OF CORPORATIONS. Alternatively, you can fill out the PDF Credit Card Authorization Form and email or fax to us at 403-934-4889. The charge may be either for a one (1) time payment or recurring. Download a credit card and ACH authorization forms which allows a third (3rd) party in the name of a business or individual to charge another person's credit card or bank account. Additionally you can click the button to go to our redemption website to view reward options and redeem accumulated points. COUNTY OF SAN LUIS OBISPO OFFICE OF THE CLERK-RECORDER Tommy Gong - County Clerk-Recorder County of San Luis Obispo Clerk -Recorder Page 1 of 1 1055 Monterey Street, Suite D120 | San Luis Obispo, CA 93408 (P) 805-781-5080 | (F) 805-781-1111 | www.slovote.com CREDIT CARD AUTHORIZATION FORM This can either be for a 1-time charge or recurring (weekly, monthly, etc). Produce this Dollar Value on the blank line labeled “(Amount $)”In addition to an authorized Dollar Amount, you must indicate when this payment should be made from your account. County Clerk-Recorder MELINDA GREENE Chief Deputy Clerk-Recorder www.SBCRecorder.com Hall of Records 1100 Anacapa Street Santa Barbara, CA 93101 ... CREDIT CARD AUTHORIZATION FORM. ߏ9"J��y�v�5���\ٸ�k��������-2��A�RW�S�Z��=L�a�K㟸�Z��KG��GgǘG��]�;�! Please note, that while the same basic information is requested in each of the choices, you should only furnish information to the paragraph attached to the check box you selected. Business Organizations; Chamber of Commerce; Small Business Loans; Visitors. By phone We can accept a check by mail (made out to Clackamas County), but we will have to keep your submittal on hold until we receive the funds. Download: Adobe PDF, MS Word (.docx), OpenDocument. x��=�o�F�����b���/I�s��!I������}H֛d�{kױ���HΌ�ъ�Yk��pw��+qH��!9������o�:yq�O�f�NO�go>x|&2��2{�������*�uV�2���?껋*����"�H�j����~��������(fo�zv�����3��a~��}v6?2��y6����_>x ��(M^�.�go�Grv��T��w�r���g�j��KJ��*�urNh�g�/�G5�H�N�ω�S��fg�(� Attach this form to your document or written request. Box 369 380 A Avenue Certified Paper Copy - $5.00 certification fee Date” along with the three-digit CVV code associated with your credit card (usually located on the signature area on the back of your Credit Card) on the blank line labeled “CVV.”, 6 – Demonstrate Your Intent To Authorize The Defined Payment Information, In order to provide proof of your approval, the Acknowledgement Statement presented should be completed. I, , give Mecklenburg County Revenue Collection Department permission to charge $ , To my (Visa/MC/Discover) for payment of estimated upfront fees for Project # . This can either be for a 1-time charge or recurring (weekly, monthly, etc). Make sure to have your account information handy when filling out this form as this will need to be presented accurately. When faxing, mailing, or e-mailing, please use the Credit Card Form below. City of Lake Oswego. Co-pays, co-insurance, and out of pocket fees are due at each session. City of Sandy 39250 Pioneer Blvd. Payment can be made by credit card using this Credit Card Authorization Form. Use the blank space below the Street Address you just entered to record the City, State, and Zip Code listed associated with Account Holder’s Billing Address on the space labeled “City, State, Zip.” The Account Holder’s Phone Number and E-mail Address should both be recorded in this area. I certify that. 3 – Furnish Your Choice With The Requested Information, Now that we have solidified how often the authorized payment is allowed, we will need to disclose some basic facts regarding the parties and amounts involved. 1-Time ACH Authorization – Make a one (1) time payment via bank account (checking or savings) by providing the Account and Routing numbers. 5 – Detail The Method Of Payment Being Authorized. A credit card authorization form allows a 3rd party to make a payment by using a person’s written consent and credit card information. What is a Credit Card Authorization Form? If a business has a dispute ratio higher than the allowed rate, their payment processor will likely suspect their business to be practicing shady ethics. Credit Card Authorization . Resources. If you intend on approving the third party’s use of your “Checking” or Savings” account to make this payment, then you must mark the appropriate check box in the “Bank (ACH)” area. P.O. ). Our support agents are standing by to assist you. If the payment you are authorizing is a recurring payment, one that your account should pay automatically every billing cycle, then place a mark in the check box labeled “Recurring Charge.” If the payment you are authorizing should only be made once, and by virtue of this form, then check the box corresponding to “One (1) Time Charge.” Keep in mind this will mean that after this payment is made, the approved party will be unable to submit the same payment at any point in the future using this authorization. County Zoning Division to process a charge against my credit card account in the amount of $_____ for the payment of: Garage Sale Permit Fee ($14) (Community Garage Sale, .50 for each additional address) Temporary Off Site Signs ($4.50 each, limit six) ... Credit Card Authorization Form Created Date: Title: authorization-to-use-credit-card (37989 clicks) Caption: Filename: authorization-to-use-credit-card-2.pdf Size: 41 KB We hope that these forms are useful for you. If being used for a hotel room authorization the form may be signed by the cardholder and faxed to the lodging establishment. Second, it prevents unwanted and fraudulent chargebacks that can hurt the relationship between a business and a merchant processor. %PDF-1.5 4 0 obj If a business is getting too many chargebacks, their merchant provider may eventually cease to do business with them. Revision Credit Card Authorization Form; Revision Transmittal; Agriculture. ... Credit Card Authorization Form . © 2020 Electronic Forms LLC. This is a common procedure when an individual authorizes a subscription that renews on a monthly basis (such as gym memberships, monthly rent, etc.). :��LC�U��R1BSdpI&0��$����9����������A>_��㘹Y��^垳�$I���v��1lg"��sd�� �lH�J#&�:�f�����_����/��VU"Ѳ�k���Y"r�H��U�: 1-Time Credit Card Authorization – A general form for a charge that will be made for a single payment on a credit card. Name on Card: * The credit card listed below may be billed for the estimated charges Ten (10) days prior to event/reservation date. PLEASE DO NOT WRITE CREDIT CARD NUMBER ON THIS FORM PEOPLE PRIDE PROGRESS PARTNERSHIPS <>>> "��Jf�6y!���f����o>����z� {��$�:�! as the transaction corresponds to the terms indicated on my request. 1 – Open And Download The Authorization Template On This Page. Use the following instructions to charge a credit card or bank account by obtaining the customer’s credentials via a paper form. The authorization hold can range from $1 dollar all the way to the full amount depending on the situation. First, it gives a business the authority to charge a credit card without the buyer being physically present. You, as the Account Holder, must sign your Full Name on the blank space labeled “Bank Account/Cardholder’s Signature” Finally, enter the Calendar Date when you signed this form on the line labeled “Date.”. Part I I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long. This paperwork will handle the task of proving your intent to allow another person to use one of your accounts to pay a bill. ... Credit Card Authorization Form. A credit card authorization form allows a 3rd party to make a payment by using a person’s written consent and credit card information. If this information is not readily available then you should contact the Merchant to satisfy this statement. All rights reserved. The following information will be required by the processor: Enter whether the account will be charged on a one-time payment or will it be continuing on a recurring basis. A credit card authorization form serves 2 primary purposes that play a large and important role for businesses and merchants. stream Please fill out all the fields below. County of Sacramento 720 9th Street Sacramento, CA 95814 916-874-5522—Website www.saccourt.ca.gov Credit Card Authorization Form Please complete one form per case number CARD HOLDER INFORMATION Name on Card: Card Holder Billing Address: City: State: Billing Zip: … Credit/Debit Card Billing Authorization Form ElderCare of Alachua County/Senior Recreation Center 5701 NW 34th Blvd, Gainesville, FL 32653 Phone: 352.265.9040 Fax: 352.265.9041 Statement of Cardholder: Please review the conditions below and initial to acknowledge your understanding and acceptance of the statements below. Credit Card/Debit Card Authorization. 9����s-�xS$�7xǃf��5*��I����x����S�e4Q�E�P,������6/u���\���+\hH���.��T L��o��_�E9;�g�6�_sj��� �e���u�y�a�H|:ul*��ϑÓ�����3 ��i. Fax (email not accepted) this completed credit card authorization form to (805) 568-3247 or Visits to open branch locations are by appointment only.Click here for branch availability.. Click here for information about PPP Loans. Download and fill out the Credit Card Authorization to allow us to charge your credit card for your Permit Fees. The Credit Report Authorization Form is a document that is used to give permission to an individual or organization to perform a credit report only.This form provides broad language that allows a credit report to be generated for any type of legal reason in compliance with the Fair Credit Reporting Act (FCRA) (15 U.S.C. I authorize Clackamas County to charge the credit card indicated above for the permits I am applying for. Title: Note: This credit card authorization form will be kept on file for 60 days from date of service. A credit card authorization form is a document, signed by a cardholder, that grants a merchant permission to charge their credit card for a period of time as written in that document. Most businesses are allowed a dispute range of no more than 1%-3%. Clackamas County Circuit Court 807 Main Street Room 104 Oregon City, OR 97045; Recurring automatic free monthly payments may be scheduled with the court using a Visa, MasterCard, or Discover Card. Title: CREDIT CARD AUTHORIZATION FORM Author: elpga Last modified by: bob Created Date: 3/16/2013 8:05:00 PM Company: University of Dallas Other titles endobj You must authorize a definitive sum of money for payment. COUNTY F L OR I D A . Any business that sees high or unfair disputes, should adopt a credit card authorization form for customers to sign anytime they can. * Hotel reserves the right to refuse a credit card authorization as a valid method of payment for same day bookings or authorization To pay fees using a credit card, simply complete and sign this form and attach it to your application. %���� Airline Credit Card Authorization – For any person seeking to pay an airline ticket via paper form. Signature Date ... Drive, Plantation, FL. Credit Card Authorization The Merced County Clerk-Recorder’s Office accepts Discover, American Express, MasterCard and Visa for payment of fees. How to Fill-out a Credit Card Authorization Form. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account. The drive up at our Canby Branch is open. COUNTY OF DUPLIN BUILDING INSPECTIONS DEPARTMENT PO BOX 950, 209 SEMINARY STREET, KENANSVILLE, NC 28349 (910) 296-2124 FAX: (910) 296-2166 CREDIT CARD AUTHORIZATION With my signature below, I hereby authorize Duplin County to charge the permit fee to my credit card. The branch will re-open for in-person appointments on Monday, January 11th. Fees are subject to change without notice. <> The section labeled “Billing Information” will seek some basic information regarding the Account Holder. Locate the blank space that follows the dollar sign in the statement beginning with the words “I Understand That This Authorization…” Record the penalty amount the Account Holder must pay each time the charge is rejected due to insufficient funds on this space. I authorize Broward County to charge to my credit card account. Thus, begin by locating the check box you marked, then enter your First, Middle, and Last Name on the first blank space (labeled “Full Name”) in that statement. To approve a third party’s use of your Credit Card for this payment, supply your Name on the blank space labeled “Card Holder Name.” Next, report the Credit Card Number you wish the funds to be drawn from on the blank space labeled “Account Number.”  Finally, transcribe the Expiration Date on your Credit Card to the lines labeled “Exp. From there you can view your point balance, see pending points, and how many points have been redeemed. They can be paid by cash, credit card, or check. For instance, you can authorize the third party’s use on “Tuesday” every “Week” or on the “15th” of every “Month.” If you have selected “One (1) Time Charge,” then enter the Calendar Date you expect the third party to pay this charge on the blank line labeled “Date.”Give a detail of what the payment is being used for on the line labeled “Description Of Goods/Services.”, 4 – Produce The Billing Information Required By The Authorization Process. As the Account Holder, you must sign this document. The cardholder must sign the authorization form. This is a common practice that gas stations and hotels widely use to prevent fraud. Due to how easy it is to call a bank and report a false or fraudulent charge, there needs to be a way for merchants to minimize losses in order to protect their business. The Name of Corporation or Other Business Entity To Which This Service Request Applies is: Use the blank spaces labeled “Phone #” and “Email” to present this information. Use the PDF, Word, or ODT button corresponding to the preview image on this page to open this document then save it to your machine. We will begin with the line labeled “Billing Address.” Use this space to report the Account Holder’s Building Number, Street Name/Number, and Unit Number listed on the account being used to pay the above-named Merchant. Hotel Credit Card Authorization – For the use of a guest that is going to be using a third (3rd) party’s credit card in order to stay at a hotel. I authorize Clackamas County to charge the credit card indicated above for the permits I am applying for. Any disputed charges made in conjunction with this request, shall be made within 45 days from date of service. If you would like a different format, we would be happy to convert the form and provide the source file within 24 hours. Please be aware that our agents are not licensed attorneys and cannot address legal questions. Form B42 Revised 10/10 BAY COUNTY BUILDERS ¶ SERVICES DIVISION 8 40 W. 11th Street Panama City, FL 32401 Phone (850) 248-8350 Fax (850) 248-8384 CREDIT CARD AUTHORIZATION The following information is required to be kept on file at the Bay County Builders ¶ Services Division. Is not readily available then you should contact the merchant to satisfy this statement the button go. About PPP Loans Department of State DIVISION of CORPORATIONS for branch availability.. Click here information! 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