CreditCardAuthorization AGREEMENT FOR CREDIT CARD PROCESSING & AUTHORIZATION FOR APPRAISAL Colonial First Mortgage Funding Corp 2641 E Atlantic Blvd, Suite 204Pompano Beach, FL 33062 Phone 954-232-7070 Fax 954-656-1097Type of Credit Card* Visa Mastercard American Express Account Number*Expiration Month*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberExpiration Year*2021202220232024202520262027202820292030CVV Security Number*Name on Card* Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social Security # Date of Birth Month Day Year Send Authorization to:*Send toBryan S MossorofoDolores ColeRichard Noel LivingstoneKelly L MossorofoJulio A Avendaño ArizI Authorize Credit Card Payment to Premium Credit Bureau. I Further declare that I am an authorized signer on said account and am/or am authorized by corporate charter or otherwise to enter this agreement.* I agree 5% CC fee added to the total cost.Authorization to run credit & authorization for appraisal.* YES - I hearby authorize Colonial First to run my credit reports and use this credit card to pay for the appraisal.
