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County of Cayuga James H. Orman Cayuga County Treasurer CREDIT CARD AUTHORIZATION FORM DIRECTIONS The Credit Card Authorization Form is used for credit card payments made by phone. The Treasurer’s Office requires signed authorization prior to processing any credit card transactions by phone. 1. Print authorization form 2. Fill out authorization form a. Date – current date b. Purpose – type(s) of taxes being paid Installment Agreement, 2017 Lien, AECS Delinquent, Current Year 2nd Installment, etc.) c. Amount – total amount of tax payment, including all penalty, interest, and/or other charges. Please call the Treasurer’s Office in advance for amount owed. d. Town – for parcel in which payment is to be applied e. School District – only fill in if you intend to pay Auburn Enlarged City School or Oswego City School delinquent taxes f. Tax Map # - for parcel in which payment is to be applied g. Complete address associated with credit card – complete mailing address associated with credit card h. Expiration Date – month and year credit card expires i. Print Card Holder Name – print name as it appears on credit card j. Telephone Number – please indicate phone number where Treasurer’s Office can reach you to obtain the Visa/Mastercard/Discover k. Sign BOTH signature lines i. The first signature authorizes the Treasurer’s Office to charge your credit/debit card for the taxes. ii. The second signature authorizes the convenience fee charged by the credit card processor (2.65% of transaction, with a $3.00 minimum fee). iii. Both cardholder authorization signature lines must be signed by the cardholder for the Treasurer’s Office to process the transaction. 3. LEAVE BLANK a. Visa/Mastercard/Discover # b. The fax machine in the Treasurer’s Office is not secure, so the account number should not be included on the form. 4. Fax signed authorization form to Treasurer’s Office at (315) 253-1369. 5. Treasurer’s Office will call the telephone number on the authorization form to get the Visa/Mastercard/Discover 6. Credit card receipt will be mailed. If you prefer your receipt be faxed or e-mailed, please notify the Treasurer’s Office when they call for your account County Office Building - 5th Floor 160 Genesee St - Auburn, New York 13021- (315) 253 -1211 Fax (315) 253-1369 ---PAGE BREAK--- County of Cayuga James H. Orman Cayuga County Treasurer CREDIT CARD AUTHORIZATION FORM Date: Purpose: Amount: Town: School District: Tax Map Visa/Mastercard/Discover Complete address associated with credit card: Expiration date: I, authorize the Cayuga County (Print Card Holder Name) Treasurer to charge my credit/debit card for the taxes on the property referenced above. I can be reached at: if questions occur. (Telephone Number) (Cardholder Authorization Signature)** I understand that this Credit Card transaction will incur a separate convenience fee of 2.65% per transaction, with a $3.00 minimum convenience fee. (Cardholder Authorization Signature)** Your transaction will not be processed without both Cardholder Authorization Signature Lines signed by the cardholder. County Office Building - 5th Floor 160 Genesee St - Auburn, New York 13021- (315) 253 -1211 Fax (315) 253-1369