Form G-1450 01/04/18
Page 1 of 1
Complete the "Applicant's/Petitioner's/Requester's Information," "Credit Card Billing Information," and "Credit Card
Information" sections and sign the authorization.
Type or print legibly in black ink.1.
2.
How To Fill Out Form G-1450
USCIS
Form G-1450
OMB No. 1615-0131
Expires 01/31/2021
Applicant's/Petitioner's/Requester's Information (Full Legal Name)
Family Name (Last Name)Middle Name (if any)Given Name (First Name)
Credit Card Information
Credit Card Billing Information (Credit Card Holder's Name as it Appears on the Card)
Given Name (First Name) Middle Name (if any) Family Name (Last Name)
Credit Card Holder's Billing Address:
Street Number and Name
Apt. Flr. NumberSte.
City or Town State ZIP Code
Credit Card Holder's Signature and Contact Information:
Credit Card Holder's Daytime Telephone Number Credit Card Holder's Email Address
Credit Card Type:
Visa
Credit Card Number
Credit Card Expiration Date
(mm/yyyy)
MasterCard
American Express
Discover
Authorized Payment Amount
$
.00
Credit Card Holder's Signature
Place your Form G-1450 ON TOP of your application, petition, or request package.
3.
NOTE: Failure to provide the requested information may result in USCIS and your financial institution not accepting the payment.
USCIS cannot process credit card payments without an authorized signature.
NOTE: Form G-1450 may only be used with a form being submitted to a USCIS Lockbox. Do not submit this form to a USCIS
Field Office. They will not accept it.
We recommend that you print or save a copy of your completed Form G-1450 to review in the future and for your
records.
Authorization for Credit Card Transactions
Department of Homeland Security
U.S. Citizenship and Immigration Services
