Credit Card Authorization Form - DOC 3 by 6Ml4e07j

VIEWS: 83 PAGES: 1

									                        LEO H. ALARCON
                     KLEBERG COUNTY CLERK
                                P.O. BOX 1327
                        KINGSVILLE, TEXAS 78364-1327
                            361-595-8548 (OFFICE)
                              361-593-1355 (FAX)



                 CREDIT CARD AUTHORIZATION

Credit Card:         MasterCard            Visa            Discover

Credit Card Number: _______________________________________

Expiration Date: _____/______

Name on Card: _____________________________________________

Address card billed to: _______________________________________

                        _______________________________________

Work Phone: _______________________________________________

Home Phone: _______________________________________________

I ______________________________ hereby authorize the Kleberg County Clerk’s
Office to process the above credit card for full payment of services rendered in the
amount of __________________ and an additional processing fee of _____________.


Date: ______________________


Cardholder’s Signature: _____________________________________

								
To top