Fillable Credit Card Authorization (Broward County)

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Credit Card Authorization (Broward County)

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The Credit Card Authorization (Broward County) form is 1 page long and contains:

  • 1 signature
  • 18 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

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BROWSE BROWARD COUNTY (FLORIDA) FORMS

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Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION
2307 West Broward Boulevard, Suite 300 • Fort Lauderdale, Florida 33312 • 954-765-4400 • broward.org/building
Credit Card Authorization
Card Information
Visa
MasterCard
Discover
American Express
Cardholder’s Name
Expiration Date
Card Verification Code (CVC)
City
State
Zip
Fax
Fee Description
License, Permit or Application #
Applicant, Facility or Project Name
Facility or Project Location
Building Records
Research Copies
Re-inspection(s)
Electrical Structural Mechanical Plumbing Zoning
(a) Elevator or Escalator BCID #
(b) Elevator or Escalator BCID #
(c) Elevator or Escalator BCID #
Notes/Other
I authorize Broward County to charge to my credit card account, plus
Signature Date
FAX this completed authorization form to 954-765-4362.
Do not upload this document to the ePermitting portal
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Credit Card Authorization (Broward County)

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Completed 8 February 2021

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