Pinole, CA · Contra Costa County
Credit Card Authorization Form
This form lets a person authorize the City of Pinole to charge a credit card for a stated amount and purpose related to a business license.
What this form is
Use this form to authorize the City of Pinole to charge a credit card for a specified amount and purpose. It requests the cardholder’s name, phone number, billing address, card type and account details, expiration date, signature, and date, along with the business license number. The form says the billing address and ZIP code must match the card’s billing information for the transaction to be processed.
Who needs it
A person authorizing a credit card charge to the City of Pinole for a stated purpose should complete and sign this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Credit Card Authorization Form PDF.
- 2
Complete The Form
Enter the requested cardholder, billing, card, charge, and business license information.
- 3
Check The Billing Address
Make sure the address and ZIP code match the credit card’s billing address.
- 4
Sign And Submit
Sign and date the form, then submit it to the city department named on the form.
Frequently asked questions
- What is the Credit Card Authorization Form for?
- It authorizes the City of Pinole to charge a specified amount to a credit card for a stated purpose. The form includes a field for the business license number.
- What information does the form ask for?
- It asks for the cardholder’s name and phone number, billing address, card type and account details, security code, expiration date, charge amount and purpose, signature, date, and business license number.
- Do I need a notary for the Credit Card Authorization Form?
- No. This document is signed and dated without a notary; the signer just signs and dates it.
- How do I submit the Credit Card Authorization Form?
- The form does not provide submission instructions. Submit it to the city department named on the form; check the city website for current contact details.