Credit Card Authorization Form THIS FORM CAN ONLY BE RECEIVED BY US MAIL, FAX OR IN PERSON FORMS RECIEVED BY EMAIL WILL NOT BE ACCEPTED THIS FORM MUST BE FULLY AND ACCURATELY COMPLETED AND SUBMITTED WITH THE ORIGINAL LICENSE FORM OR ALL DOCUMENTS WILL BE RETURNED. THIS OFFICE DOES NOT ACCEPT INCOMPLETE FORMS. The Commission will only accept VISA, MASTERCARD AND DISCOVER (we cannot accept cards that are debit only). To pay license fees by credit card, attach this fully completed Authorization Form to your license document. You may use this Authorization Form to pay for multiple licenses. Credit card capability will be accepted for original applications, transfers, change of address/change of firm name, active status request, renewals, publications and certification of license history requests. The signature below authorizes the Commission to charge applicable fees for those individuals listed below to the following credit card. (Double-check all information for accuracy). CREDIT CARD NUMBER: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ CVV2 CODE: _______________ (3 digit # on the back of the card) EXPIRATION DATE: MO _____ YR________ NAME AS IT APPEARS ON THE CARD: __________________________________________ BILLING ADDRESS: __________________________________________________ ZIP:_____________ SIGNATURE: ___________________________________ DATE: _______________________ THIS DOCUMENT WILL BE SHREDDED WHEN PAYMENT HAS PROCESSED. ---------------------------------------------------------------------------------------------------------------------PAYMENT IS AUTHORIZED FOR THE FOLLOWING LICENSEE(S): PROVIDE FIRST AND LAST NAME. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ AMOUNT $ __________ For Commission use only:

Date Processed_______________________ Amount Processed____________________ Authorization Code___________________

Wyoming Real Estate Commission, 2617 E. Lincolnway, Suite H, Cheyenne, WY 82002 Phone: (307) 777-7141 Fax: (307) 777-3796

Credit Card Authorization - Fillable.pdf

There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. Credit Card ...

18KB Sizes 0 Downloads 156 Views

Recommend Documents

Credit Card Authorization Form.pdf
RECEIVED BY ACCOUNT MANAGER POSTED BY DATE. HST REGISTRATION #: 8197-08926-RP0001. Page 1 of 1. Credit Card Authorization Form.pdf.

credit card form.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Try one of the apps below to open or edit this item. credit card form.

CREDIT CARD FORM.pdf
Expiration Date: ______/______. Your order will be processed securely through Paypal. Page 1 of 1. CREDIT CARD FORM.pdf. CREDIT CARD FORM.pdf.

Credit Card Flyer.pdf
Sign in. Main menu.

GAP 16 Credit Card Form.pdf
GAP 16 Credit Card Form.pdf. GAP 16 Credit Card Form.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying GAP 16 Credit Card Form.pdf.

Credit Card Fraud Detection Using Neural Network
some of the techniques used for creating false and counterfeit cards. ..... The illustration merges ... Neural network is a latest technique that is being used in.

Visa Platinum Credit Card Application.pdf
FOR SECURITY PURPOSES, COMPLETED APPLICATIONS MAY NOT BE RETURNED VIA EMAIL. Page 3 of 4. Visa Platinum Credit Card Application.pdf.

Credit Card Payment Form.pdf
Credit Card Payment Form.pdf. Credit Card Payment Form.pdf. Open. Extract. Open with. Sign In. Main menu. Displaying Credit Card Payment Form.pdf.

Visa Platinum Credit Card Application.pdf
Visa Platinum Credit Card Application.pdf. Visa Platinum Credit Card Application.pdf. Open. Extract. Open with. Sign In. Main menu.

District Credit Card Information.pdf
MasterCard 1,000.00 Technology Services Manager 9835. SAGINAW INTERMEDIATE SCHOOL DISTRICT. DISTRICT CREDIT CARD INFORMATION.

Comparison of credit card fees.pdf
There was a problem previewing this document. Retrying... Download. Connect more apps... Comparison o ... ard fees.pdf. Comparison of ... card fees.pdf. Open.