Section 1 of 1 in this document

Special Event Payment Form

Event Information

Permit Number

Event Name

Organization Name

Payment

Your payment amount must match what's on your application. Payments that do not match will result in an incomplete permit. Please enter permit amount into the "Qty" box.

Pay with Xpress Bill Pay

	Special Event Permit	1
Subtotal

Card Holder Name *

Credit Card Number *

Security Code *

Exp Month *

Exp Year *

Who should the deposit refund check be made out to?

Signature

Phone Number

Email (used to email your receipt)

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.