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COMPLETE, PRINT, SIGN, AND MAIL OR FAX (If paying with credit card, complete Credit Card Payment Authorization) For Office Use OnlyCONTRACTOR LICENSE RENEWAL APPLICATION SECRETARY OF STATED Number:
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This form is a document used to authorize the use of a credit card for payment purposes.
Any individual or entity wishing to use a credit card for payment may be required to fill out this form.
To fill out the form, you typically need to provide details about the credit card being used, the amount to be charged, and the authorization signature.
The purpose of the form is to authorize the use of a credit card for payment and protect against unauthorized charges.
Information such as the credit card number, expiration date, cardholder name, amount to be charged, and authorization signature are typically required.
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