Alabama Secretary of State Credit Card Payment Slip

Download and use this form for Credit Card Payment Slip to the Secretary of State in Alabama.

Alabama Secretary of State Credit Card Payment Slip

Text Version of this Form

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STATE OF ALABAMA
OFFICE OF THE SECRETARY OF STATE
BUSINESS SERVICES DIVISION
FAX (334) 240-3138

MAILING ADDRESS PHYSICAL ADDRESS
PO Box 5616 RSA Union Bldg, Suite 770
Montgomery, AL 36103-5616 100 North Union Street
Montgomery, AL 36130

CREDIT CARD PAYMENT SLIP

Card Type: (Visa, MasterCard, Discover, and American Express)

Card Number:

Expiration Date (Mo/Yr – 4 digits required): /

Card Holder Name:

Billing Address:

City/State/Zip: ,

Typed Name of Authorized Signature:
**Name should only differ from Card Holder if this is a corporate/business card. **

Authorized Signature for Card Holder:

CC SLIP – 8/2010