Fillable City of Council Bluffs (City of Council Bluffs)

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City of Council Bluffs (City of Council Bluffs)

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City of Council Bluffs
City Treasurer
209 Pearl Street
Council Bluffs, IA 51503
Phone (712) 890-5316
Fax (712) 328-4689
Credit Card Authorization Form
The City of Council Bluffs, Iowa is authorized to charge the following
credit card for permits upon my written authorization which will be
evidenced on each individual permit application.
Company
Credit Card Number
Credit Card Expiration
Validation Code
Please print your name
Address
Phone Number
Signature
Date
Note: The City of Council Bluffs will accept this form as a fax for your first permit
only. Please mail this original document to the City Treasurer (address above)
for all future permits. A new form will need to be submitted upon any change
made to the information above. Thank you.
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City of Council Bluffs (City of Council Bluffs)

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Completed 17 July 2020

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