CREDIT CARD AUTHORIZATION FORM - South Dakota Department of Labor and Regulation

Sep 17, 2026

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Credit card authorization form from the South Dakota Department of Labor and Regulation and the South Dakota State Board of Technical Professions to collect billing consent. The form requires mailing or faxing to the office and explicitly does not accept submissions via email. It captures transaction date, authorized amount, card type (Visa or MasterCard), applicant identity, the name on the card, card number, and expiration date. Office-use fields include reason, receipt number, and whether Authorize.Net processing is needed with the associated date.

LanguageEnglish

CategoryLetters

FormatPDF

Pages1

AccessFree to download

Credit Card Authorization Form

Applicant and Card Details

Payment Authorization and Office Use

FAQs

How must the credit card authorization form be submitted?

Mail or fax the form to the office. Email submissions are not accepted and will not be processed.

Which payment card details are required on the form?

The form collects the card type (Visa or MasterCard), card number, expiration date, and the name shown on the card.

What information is reserved for office use?

Office-use fields include the reason, receipt number, and whether it needs to run through Authorize.Net, along with the date.

Sep 17, 2026

Upload by Rizky