BANKCARD TRANSACTION FORM
This form must be completed and submitted with a picture I.D. (valid driver’s license,
Georgia State I.D., etc.) of the person responsible for the credit card account.
Transaction cannot be processed unless all information is submitted.
Type of Bankcard: VISA MASTERCARD
Payment amount: $
Bankcard number:
Expiration date of card (mm/yy):
(Required) Validation (v) – 3 digit code on back of card:
Name on bankcard:
Company name:
(Required) Zip Code for bankcard:
Contact person:
Contact telephone number:
Payment rendered for: (check one)
Commercial Plan Review
FORSYTH COUNTY, GA – BANKCARD TRANSACTION FORM -1-