Form 610 "Credit Card Authorization Form" - Alaska

What Is Form 610?

This is a legal form that was released by the Alaska Department of Administration - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the Alaska Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 610 by clicking the link below or browse more documents and templates provided by the Alaska Department of Administration.

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Download Form 610 "Credit Card Authorization Form" - Alaska

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State of Alaska
Division of Motor Vehicles
Credit Card Authorization Form
Driver license records are confidential; therefore, you may only obtain your personal record, unless you have a
signed release to obtain a record for another person per AS 28.10.505. Please call (907) 269-5551
for questions regarding this form or the reinstate process.
CREDIT CARD HOLDER INFORMATION
Please DO NOT email or fax credit card information.
Please check credit card type:
Visa
MasterCard
Credit card number: ________/________/________/________
Visa Card only - VIN Code:
Expiration Date: _______/_______ (mm/yy)
Name as it appears on the credit card: __________________________________________________________
Please check the following that apply:
Reinstatement fee:
$___________
Other: Explain _________________________________
$___________
_________________________________
Total amount to be charged:
$ ___________
Daytime Phone Number: ____________________
Cardholder Signature: _________________________________________ Date: _____________________
RECORD/DRIVER INFORMATION
Name as it appears on Driver’s License: _________________________________________________________
Record/Driver license number: __________________________________________________________
OR
Date of Birth: ______/______/__________
AND
SSN: ______/_____/_________
mm
dd
yyyy
The Record Holder/Driver may request a clearance letter by completing a Driving Record Request (Form 419F)
and sending along with this Credit Card Authorization Form. There is a $10 additional fee for a clearance
letter.
MAIL: Division of Motor Vehicles
3901 Old Seward Hwy STE 101
Anchorage, AK 99503-3600
Allow 3 business days for processing.
www.alaska.gov/dmv
Form 610 (Rev 10/2020)
Credit Card Authorization Form
State of Alaska
Division of Motor Vehicles
Credit Card Authorization Form
Driver license records are confidential; therefore, you may only obtain your personal record, unless you have a
signed release to obtain a record for another person per AS 28.10.505. Please call (907) 269-5551
for questions regarding this form or the reinstate process.
CREDIT CARD HOLDER INFORMATION
Please DO NOT email or fax credit card information.
Please check credit card type:
Visa
MasterCard
Credit card number: ________/________/________/________
Visa Card only - VIN Code:
Expiration Date: _______/_______ (mm/yy)
Name as it appears on the credit card: __________________________________________________________
Please check the following that apply:
Reinstatement fee:
$___________
Other: Explain _________________________________
$___________
_________________________________
Total amount to be charged:
$ ___________
Daytime Phone Number: ____________________
Cardholder Signature: _________________________________________ Date: _____________________
RECORD/DRIVER INFORMATION
Name as it appears on Driver’s License: _________________________________________________________
Record/Driver license number: __________________________________________________________
OR
Date of Birth: ______/______/__________
AND
SSN: ______/_____/_________
mm
dd
yyyy
The Record Holder/Driver may request a clearance letter by completing a Driving Record Request (Form 419F)
and sending along with this Credit Card Authorization Form. There is a $10 additional fee for a clearance
letter.
MAIL: Division of Motor Vehicles
3901 Old Seward Hwy STE 101
Anchorage, AK 99503-3600
Allow 3 business days for processing.
www.alaska.gov/dmv
Form 610 (Rev 10/2020)
Credit Card Authorization Form