"Credit Card Authorization Form" - Idaho

Credit Card Authorization Form is a legal document that was released by the Idaho State Police - a government authority operating within Idaho.

Form Details:

  • Released on August 21, 2018;
  • The latest edition currently provided by the Idaho State Police;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Idaho State Police.

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Idaho State Police
Alcohol Beverage Control
CREDIT CARD AUTHORIZATION FORM
***Please note: There is an additional processing fee of 3% of the total transaction plus $1.00, for all
payments made by credit or debit card. Depositing of fees does not guarantee the issuance of a license or
permit. Returned payments will result in an incomplete license/permit application.***
If paying by credit or debit card, please complete the following:
Name of Applicant/Business Name:
Doing Business As (DBA) Name:
ABC Premises Number (If Issued):
Purpose for Payment:
Amount: $
Credit Card Type
Visa
AmEx
MasterCard
Discover
Credit Card Number:
/
Expiration Date:
CVV:
Zip Code (Required):
Name as it appears on card:
Phone Number:
(Phone number is required in case we need clarification or have questions regarding payment.)
E-mail:______________________________________________
Signature of Payee
:
(Required before mailing or faxing)
Electronic signatures will not be accepted
Phone: (208) 884-7060
Fax: (208) 884-7096
700 S. Stratford Dr., Ste. 115
Meridian, ID 83642
8/21/2018
Idaho State Police
Alcohol Beverage Control
CREDIT CARD AUTHORIZATION FORM
***Please note: There is an additional processing fee of 3% of the total transaction plus $1.00, for all
payments made by credit or debit card. Depositing of fees does not guarantee the issuance of a license or
permit. Returned payments will result in an incomplete license/permit application.***
If paying by credit or debit card, please complete the following:
Name of Applicant/Business Name:
Doing Business As (DBA) Name:
ABC Premises Number (If Issued):
Purpose for Payment:
Amount: $
Credit Card Type
Visa
AmEx
MasterCard
Discover
Credit Card Number:
/
Expiration Date:
CVV:
Zip Code (Required):
Name as it appears on card:
Phone Number:
(Phone number is required in case we need clarification or have questions regarding payment.)
E-mail:______________________________________________
Signature of Payee
:
(Required before mailing or faxing)
Electronic signatures will not be accepted
Phone: (208) 884-7060
Fax: (208) 884-7096
700 S. Stratford Dr., Ste. 115
Meridian, ID 83642
8/21/2018