Case File
efta-efta00589299DOJ Data Set 9OtherGOVERNMENT OF
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00589299
Pages
1
Persons
0
Integrity
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Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
GOVERNMENT OF
THE UNEED STATES VIRGIN ISLANDS
OFFICE OF THE LIEUTENANT GOVERNOR
DIVISION OF BUSINESS AND FINANCIAL MANAGEMENT
I 105 King Dreel • Chrislionslect nip Islands 00820 • 340.7716449 •
ILL Kon0ens Gods • Chmlolle Amok.. %Amin WOMIS 00802 • 340174.2291 •
CREDIT CARD AUTHORIZATION FORM
PLEASE PRINT OUT AND COMPLETE THIS AUTHORIZATION AND RETURN IT TO
OUR OFFICE BY FAX: (340) 776-5039 OR BY REGULAR MAIL. (Please provide a copy of
your personal identification e.g. driver's license or passport)
Date: March 20.2015
Cardholder Name:
Contact Number :
-
-
Email:
Signature:
Billing Address:
Credit Card Type:
K VISA K MASTERCARD K ATM/ATH CARD
Credit Card Number:
Expiration Date:
/
Card Identification Number (last 3 digits located on the back of the credit card):
Amount Charged: 22 303.07 (USD)
Apply Amount to: 2014 Property Taxes - Parcel 1-09803-0101-00
EFTA00589299
Technical Artifacts (4)
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Fax
FAX: (340) 776-5039Phone
(340) 776-5039Phone
340.7716449Phone
803-0101Forum Discussions
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