Edit, Download, and Sign the City of Phoenix Payment Authorization Form
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How do I fill this out?
To fill out this form, provide all requested card and billing information. Ensure you specify the program or service for which the payment is made. Sign and submit the form as instructed.
How to fill out the City of Phoenix Payment Authorization Form?
1
Provide cardholder and payment information.
2
Indicate the description of the program or services.
3
Fill out card type, card number, and expiration date.
4
Include necessary email addresses and phone numbers.
5
Sign and submit the form via mail, fax, or in-person.
Who needs the City of Phoenix Payment Authorization Form?
1
Businesses paying for city permits and licenses.
2
Developers submitting payments for building inspections.
3
Contractors renewing their self-certification programs.
4
Property managers paying elevator program invoices.
5
Project managers for steel fabrication approval payments.
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What are the instructions for submitting this form?
To submit this form, complete all required fields and sign the authorization section. Submit via mail to City of Phoenix, Planning and Development Department, 200 West Washington Street, 3rd Floor, Phoenix, Arizona 85003. Alternatively, fax the form to 602-534-1810. Do not email credit card information. For further assistance, contact Planning & Development at 602-262-7811.
What are the important dates for this form in 2024 and 2025?
Ensure form submission by relevant payment deadlines in 2024 and 2025. Check specific program details.
What is the purpose of this form?
This Credit Card Authorization Form is designed to facilitate one-time credit card payments to the City of Phoenix's Planning and Development Department. It allows alternate users to securely authorize payments for various city programs and services. The form ensures compliance with PCI data security standards and helps maintain accurate payment records.
Tell me about this form and its components and fields line-by-line.
- 1. Cardholder's Name: Name of the credit cardholder authorizing the payment.
- 2. Amount: Total amount to be charged to the credit/debit card.
- 3. Description of Program/Services: Details of the program or service the payment is for.
- 4. Card Type: Type of credit card being used (e.g., Visa, MasterCard).
- 5. Card Number: The credit card number for the payment.
- 6. Cardholder's Signature: Signature of the cardholder authorizing the payment.
- 7. Cardholder's Email: Email address of the cardholder for receipt confirmation.
- 8. Billing Address: Billing address associated with the credit card.
- 9. Authorized Person: Person authorized to use the card (if different from the cardholder).
- 10. Contact Person: Person to contact regarding the payment (if different from the cardholder).
- 11. Expiration Date: Expiration date of the credit card.
- 12. Receipt Requested: Indicate if a receipt is requested (Yes or No).
What happens if I fail to submit this form?
Failure to submit this form may result in delays or inability to process your payment. Ensure timely submission to avoid issues.
- Payment Delays: Delays in processing payments may occur.
- Service Disruption: Required services may be delayed or canceled.
- Late Fees: Additional fees may be incurred for late payments.
How do I know when to use this form?
- 1. Alternate Users: When an alternate user is making the payment.
- 2. Mail or Fax Payments: If submitting payment via mail or fax.
- 3. Program Fees: For payments associated with various city programs or services.
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What type of payment information is required?
You need to provide cardholder name, card number, expiration date, and billing address.
What programs or services can this form be used for?
It can be used for various city programs such as permits, self-certifications, and invoice payments.
How secure is my payment information on this form?
The form ensures secure handling of payment information in compliance with PCI standards.
What should I do if I encounter issues filling the form?
You can contact the City of Phoenix Planning & Development Department for assistance.
Can this form be submitted electronically?
Yes, you can submit the form via fax or mail as indicated in the instructions.
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