FBI Credit Card Authorization

Credit Card Authorization Form

Sign and complete this form to authorize Apply Ready License Processing Inc. to transact, process and make a payment to FBI FINGERPRINT PROCESSOR using the credit card information listed below.

By signing this form, you authorize Apply Ready to process your chosen FBI FINGERPRINT PROCESSOR application, prepare and accomplish FBI FINGERPRINT PROCESSING paperwork and make payment to your chosen FBI FINGERPRINT PROCESSOR on your behalf using the credit card details you provide on this form. This is authorization for Apply Ready to transact on your behalf with FBI FINGERPRINT PROCESSOR to use the credit card provided below, and does not provide authorization for any additional unrelated debits or credits to your account. Note: The amount charged to the credit card will be reflected as a charge from your chosen FBI FINGERPRINT PROCESSOR and NOT Apply Ready on your billing statement.

I [Cardholder Name] (name on credit card), authorize Apply Ready License Processing Inc. to make payment to my chosen FBI FINGERPRINT PROCESSOR on my behalf using my credit card account indicated below for [Amount] (amount). on [Date] (date).

Type of Payment: [Payment Type] (Fingerprinting)
Branch/Location: [Location] (Apply Ready MANILA)

Billing Address of Credit Card: [Billing Address]
Phone: [Phone Number]

City, State, Zip: [City, State, Zip]
Email: [Email Address]

Answer the following fields based on the [Field] above.

* Indicates required field

Cardholder Name: *

Amount: *

Date: *

Payment Type: *

Location: *

Billing Address: *

Phone Number: *

City, Address, Zip: *

Email: *

Account Type: *

Visa Mastercard AMEX Discover

Cardholder Name: *

Account Number: *

Expiration Date: *

CVV2 (3 OR 4 digit number on back of Visa/MC, 4 digits on front of AMEX): *

"I authorize APPLY READY LICENSE PROCESSING INC to transact & make payment to chosen FBI FINGERPRINT PROCESSOR on my behalf using the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I understand that the service charge will be from my chosen FBI FINGERPRINT PROCESSOR and NOT Apply Ready and I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form."

Signature: *

Max file size: 20MB

Date: *

Submit

Credit Card Authorization Form

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