San Benito, TX · Cameron County
One Time Credit Card Payment Authorization Form
This form lets a cardholder authorize a single credit card charge to the City of San Benito for a specified amount and payment purpose.
What this form is
Use this form to authorize the City of San Benito to charge a card once for a stated amount, on or after a specified date. It asks for the payment purpose, billing and contact information, card details, and the cardholder’s signature and date; the form states that a 4% convenience fee will be charged.
Who needs it
A cardholder authorizing a one-time credit card payment to the City of San Benito 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 form is signed and dated without a notary; the cardholder signs and dates it, and no notarized attachment or sworn step is stated.
How to submit this form
- 1
Download The Form
Download the One Time Credit Card Payment Authorization Form.
- 2
Complete The Form
Enter the payment amount, date, purpose, billing and contact information, and card details.
- 3
Sign And Date
The cardholder signs and dates the authorization.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the One Time Credit Card Payment Authorization Form do?
- It authorizes the City of San Benito to charge the card listed on the form once, for the stated amount and payment purpose, on or after the stated date.
- What information does the form ask for?
- It asks for the payment amount, date and purpose; billing and contact information; card type and details; and the cardholder’s signature and date.
- Do I need a notary for the One Time Credit Card Payment Authorization Form?
- No. The cardholder signs and dates this form without a notary; no notarized attachment or sworn step is stated.
- How do I submit the One Time Credit Card Payment Authorization Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This One Time Credit Card Payment Authorization Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.