Date
BILL NUMBER(S)
TAXPAYER'S NAME & PHONE NUMBER:
Name
AREA CODE
Phone Numbe
r
EXACT NAME AS SHOWN ON CARD:
EXPIRATION DATE ON CARD:
Month Year
AND
ADDRESS ON BILL IS CORRECT FOR SENDING RECEIPT
MAILING ADDRESS FOR RECEIPT IF DIFFERENT THAN ADDRESS LISTED ON BILL(S):
5 DIGIT ZIP CODE
YES
TYPE OF CREDIT CARD: MASTERCARD VISA DISCOVER AMERICAN EXPRESS
V - CODE:
CREDIT CARD NUMBER:
ADDRESS VERIFICATION:
SIGNATURE AND DATE
:
HOUSE NUMBER
BOONE COUNTY COLLECTOR'S OFFICE
CREDIT CARD PAYMENT BY FAX (573) 886-429
4
(
)
A credit card convenience fee of 2.30% will be added to the total amount of property taxes charged to your credit card when
paying by fax; minimum fee is $1.50. All convenience fees charged on credit card transactions are retained by the payment
processing company. The Boone County Collector's office does not charge or retain any of these fees.
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