Fillable City of Garden Grove Credit Card Authorization (City of Garden Grove)

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City of Garden Grove Credit Card Authorization (City of Garden Grove)

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The City of Garden Grove Credit Card Authorization (City of Garden Grove) form is 1 page long and contains:

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  • 4 check-boxes
  • 31 other fields

Country of origin: US
File type: PDF

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City of Garden Grove Credit Card Authorization
CITY OF GARDEN GROVE
Finance Department – Business Tax
11222 Acacia Parkway
Garden Grove, CA 92840
Tel. (714) 741-5074
www.ci.garden-grove.ca.us
Use this form to authorize payment by credit card via email
for a Business License from the City of Garden Grove.
DO NOT FAX
Attention to: ________________________________________
Business Tax Representative’s name
Business Name
Business Tax Certificate Number
(if known)
Type of Card
Reason for Charge
□ Visa □Discover □ MasterCard □AmEx
Credit Card Account Number
Expiration Date
V-Code
Amount of Charge
Cardholder’s Name
Card Billing Address: (Street #, Street Name, Unit #)
City
State
Zip
Phone # (for any issues with the card)
Email
Signature of Authorization
Date
I authorize the City of Garden Grove to charge my card listed above:
X
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City of Garden Grove Credit Card Authorization (City of Garden Grove)

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Completed 30 May 2021

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