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					*CONVENIENCE FEE (B)
All Suffolk County Treasurer’s Office Discover Card users will be charged a Convenience Fee based on the chart below. Please add this fee to your tax amount as indicated. A total combined charge will appear on your next credit card statement. TAX AMOUNT TO BE CHARGED: $ 0.00 to $ 500.01 to $ 1,000.01 to $ 2,000.01 to $ 3,000.01 and CONVENIENCE FEE:

$ 500.00..................................................... $ 5.00 $ 1,000.00.....................................................$ 12.00 $ 2,000.00.....................................................$ 23.00 $ 3,000.00.....................................................$ 38.00 up .............................................................$ 50.00

To charge your payment to your Discover Credit Card, please complete the information below and return the bill and form to the Suffolk County Treasurer, 330 Center Drive, Riverhead, New York 11901-3311. PLEASE NOTE THAT ALL CHARGES MADE TO THE SUFFOLK COUNTY TREASURER ARE SUBJECT TO A CONVENIENCE FEE AS NOTED ABOVE. PROPERTY OWNER: CARDHOLDER’S NAME: CARDHOLDER’S BILLING ADDRESS: ACCOUNT #: A) AMOUNT OF TAX TO BE CHARGED**: $ B) AMOUNT OF CONVENIENCE FEE*:
WILL BE AUTOMATICALLY ADDED IF NOT INCLUDED

EXPIRATION DATE:

$ $

(See chart above)

C) TOTAL AMOUNT TO BE CHARGED:
(A + B)

I authorize the Suffolk County Treasurer’s Office to charge my Discover card not to exceed the tax amount, plus applicable convenience fee, as indicated above. I understand that a convenience fee will be automatically added to my charge if not included above. CARDHOLDER’S SIGNATURE: TELEPHONE NUMBER:
(Please indicate a number where you may be reached during the day in the event that a problem exists with this transaction.)

DATE:

**Please indicate the parcel identification #s below and amount to be charged for each parcel. One convenience fee will be charged based on the total tax to the individual card. PARCEL IDENTIFICATION NO. TAX AMOUNT TO BE CHARGED $ $ $ $ $ TOTAL (A)$


				
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