Case File
efta-efta01078076DOJ Data Set 9OtherGOVERNMENT OF
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01078076
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
GOVERNMENT OF
THE UNTIED STATES VIRGIN ISLANDS
OFFICE OF THE LIEUTENANT GOVERNOR
DIVISION OF BUSINESS AND FINANCIAL MANAGEMENT
1105 King Slreel • ChMHonied. Vin Islands00820 • 340.773.6449 •
18 Raiment Gale • ChoRolle Amore. Viloin Woods 00802 • 340.774.2791 •
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
EFTA01078076
Technical Artifacts (4)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Fax
FAX: (340) 776-5039Phone
(340) 776-5039Phone
340.773.6449Phone
340.774.2791Forum Discussions
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