Authorization Agreement for Credit Card Payment

*	HOA Account No.
*	First Name
*	Last Name
*	Address
*	City
*	State	-Select- Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Lousiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
*	Zip
*	Email

This authorizes a one-time charge to your credit card for your homeowner assessment or other charges assessed to your account. The application of funds against your account will be in accordance with the Association’s collection resolution or policy concerning credit card payments.

**Please make sure all fields are complete. Incorrect information may cause a delay in processing. Once all information has been submitted, you will receive an email confirming we have received your request. If you experience problems with this form, please contact CardFlex at 866-634-3044.

Please contact Christan Lamoureaux at (303) 745-2220 if you have billing questions or questions regarding the convenience fee.

* = indicates required field Property Information Billing Information Note: the address entered here must match the billing address on your credit card statement. Check if same as property address information * First Name     * Last Name     * Billing Address     * Billing City   * Billing State -Select- Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Lousiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming   * Billing Zip     * Credit Card No.   * Expiration Date -Select- 01 02 03 04 05 06 07 08 09 10 11 12 -Select- 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 * Security Code:   3 or 4 digit security code on the back of your credit card. * Amount of Payment