GOVERNMENT OF THE VIRGIN ISLANDS
GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES OFFICE OF THE LIEUTENANT GOVERNOR 5049 Kongens Gade, St. Thomas, Virgin Islands 00802 NOTARY DIVISION NOTARY CREDIT CARD AUTHORIZATION FORM Please print, sign and return this authorization form to our office by Postal Mail. (Please provide a copy of your personal identification e.g. driver’s license or passport) Date: __________ Cardholder Name: ________________________ Email: __________________________________ Contact Phone Number: 1 ________________________ Billing Address: ____________________________ ____________________________ __________________________ Credit Card Type or: ATM/ATH CARD Print Name: Signature: _ ( ) SIGN
Download the original document · Plain text (TXT) · Browse the archive · How this archive works
Original source: https://web.archive.org/web/20220418012740id_/https://ltg.gov.vi/wp-content/uploads/2022/03/Notary-CCard-Authorization-Form-Rev.2022.pdf
SHA-256 8212cd28956f473aa1623a410a4362bb57ab854d0a4dbbdf901ad4b47a2522c9
Re-using this document
A public record of the Government of the Virgin Islands, published by the agency itself. No copyright is asserted on it and 17 U.S.C. § 105 does not reach territorial government, so it publishes as a territorial public record.
Our description, tagging, arrangement, extracted text and machine transcripts are released under CC0 1.0. We assert nothing about the document itself.
Archive identifier LF-8212cd28956f
Document text
GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES OFFICE OF THE LIEUTENANT GOVERNOR 5049 Kongens Gade, St. Thomas, Virgin Islands 00802 NOTARY DIVISION NOTARY CREDIT CARD AUTHORIZATION FORM Please print, sign and return this authorization form to our office by Postal Mail. (Please provide a copy of your personal identification e.g. driver’s license or passport) Date: __________ Cardholder Name: ________________________ Email: __________________________________ Contact Phone Number: 1 ________________________ Billing Address: ____________________________ ____________________________ __________________________ Credit Card Type or: ATM/ATH CARD Print Name: Signature: _ ( ) SIGN