HomeMy WebLinkAboutLetter of Authorizationl.-¿tk{.eLM
Community Development - Transaction Receipt
Response Success
Amount $100.00
Pay Here Permit fee amount on application Communíty Development
Phone Number 9706254050
Billing Address po box 152 rifle co 81650
Account Type Visa
Card Number XXXX-XXXX-XXXX-1 629
Name john starr
Billing Address po box 152 rtÍle, CO 81650
Email Address john@cmgus.com
Reference Number XTF2J03PLA7
Authorization Ag reement
l, john starr, aulhorize Gommunity Development to electronically charge my credit card account for the
amount indicated above.
My entry of the information above and the checking of my acceptance of this agreement shall be my signature to
execute this transaction.
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