Credit Card Payment

Credit Card Payment

Today's Date: 

Your Name: 

Address: 

Contact Number: 

Email : 

At my request, I herby authorize Town of Bancroft to charge the following to my Credit Card along with

1.75% Credit Card Convenience Fee:  

Property Tax Roll Number:  Amount:

Utility Account Number: Amount: 

Other:  Amount: 

Please note that we are unable to accept American Express or Visa Debit Cards as a method of payment at this time.

Credit Card Number:  Exipry:  CVV:  (3 digit code on the back of Card)

Cardholder's Name: 

I, authorize the Town of Bancroft to charge the credit card indicated in this authorization from as I certifiy that I am the authorized user of this credit card. This payment authorization is for the goods/services described above and 1.75% Credit Card Convenience Fee (Resolution # 231-2022, By-Law No. 64-2022) added on top of authorized amount. This form is valid for one time use only.

You will receive an automated email response to the email addess indicated above. 



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