Payment Plan-Credit Card Authorization
GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF REAL PROPERTY TAX 1105 King Street • Christiansted, Virgin Islands 00820 • 340-773-6449 • 5049 Kongens Gade • Charlotte Amalie, Virgin Islands 00802 • 340-774-2991 • Apply to Parcel #: - ____ ____ - ____ ____- ____ __ Signature: Apply to Other: SINGLE-USE CREDIT CARD AUTHORIZATION FOR PAYMENT PLANS Please print, sign and return this authorization form to our office by the following methods: By Fax to any District:(340) 776-5039 By Email to any District: paymentplans@lgo.vi.gov, By Postal Mail: Office of the Tax Collector 5049 Kongens Gade Charlotte Amalie, VI 00802 ______________________________________________________________________________ * Check this Box if this payment is for an Installment Payment Agreement (IPA): Date: _____________________ Cardholder Name: ___________________________________________________ Credit Card Type: VISA MASTERCARD ATM/ATH CARD Credit Card Number: ________________________________________________________ Expiration Date: ____________________ Card ID Number (3 …
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GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR DIVISION OF REAL PROPERTY TAX 1105 King Street • Christiansted, Virgin Islands 00820 • 340-773-6449 • 5049 Kongens Gade • Charlotte Amalie, Virgin Islands 00802 • 340-774-2991 • Apply to Parcel #: - ____ ____ - ____ ____- ____ __ Signature: Apply to Other: SINGLE-USE CREDIT CARD AUTHORIZATION FOR PAYMENT PLANS Please print, sign and return this authorization form to our office by the following methods: By Fax to any District:(340) 776-5039 By Email to any District: paymentplans@lgo.vi.gov, By Postal Mail: Office of the Tax Collector 5049 Kongens Gade Charlotte Amalie, VI 00802 ______________________________________________________________________________ * Check this Box if this payment is for an Installment Payment Agreement (IPA): Date: _____________________ Cardholder Name: ___________________________________________________ Credit Card Type: VISA MASTERCARD ATM/ATH CARD Credit Card Number: ________________________________________________________ Expiration Date: ____________________ Card ID Number (3 digits located on the back of the credit card): ___________ Billing Address: _____________________________________________________ _____________________________________________________ _____________________________________________________ Contact Number : ______________________ Email: ________________________ Amount to be Charged: (USD)$________________ SIGN