Credit Card Payment

Credit Card Payment

Today's Date: 

Your Name: 

Address: 

Contact Number: 

Email : 

At my request, I herby authorize Town of Bancroft to charge the following to my Credit Card:

Property Tax Roll Number:  Amount:

Utility Account Number: Amount: 

Other:  Amount: 

Please note that we are unable to accept American Express as a method of payment at this time.

Credit Card Number:  Exipry:  CVV:  (3 digit code on the back of Card)

Cardholder's Name: 

I authorize the Town of Bancroft to charge the credit card indicated in this authorization from as I certifiy that I am the authorized user of this credit card. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only.

You will receive an automated email response to the email addess indicated above. 



Security Measure