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It requires essential cardholder information, including the card number, expiration date, billing address, and the specific license plate or record number associated with the transaction. The document clearly outlines strict security protocols, prohibiting the submission of this form via email, and emphasizes compliance with NRS 353.1467 regarding transaction limits. By signing, the cardholder certifies authorized use and agrees to non-dispute terms for the specified transaction amount. This one-time use authorization ensures that sensitive financial data is handled securely for office processing, while clearly separating authorized user responsibilities and administrative requirements for DMV personnel.","555 Wright Way Carson City, NV 89711  \nReno/Carson City (775) 684-4368 Las Vegas area (702) 486-4368  \n [dmv.nv.gov](dmv.nv.gov)  \nPayment Authorization Form  \nDo Not Email Form  \nDebit or Credit Card Number (One number per box)  \n\n|  |  |  |  | - |  |  |  |  | - |  |  |  |  | - |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n\nExpiration Date  \nPayment Type: ☐ Master Card ☐ Visa ☐ Discover Card  \n\n|  |  | / |  |  |\n| --- | --- | --- | --- | --- |\n\nMonth Year  \nCardholder Information  \nPrinted Name:   Payment Amount (Required) :   Print your name as it appears on your card  \nPursuant to NRS 353.1467 , credit card payments of $10,000 or more are not permitted and cannot be split between multiple payments and/or card types  \nCardholder Billing Address:    \nStreet Address or P.O. 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