Credit Card Revision Form

  • Credit Card Revision Form

  • Your completion of this authorization form helps us to protect you, our valued customer, from credit card fraud. All information entered on this form will be kept strictly confidential. Primary cards listed below will be charged first for any services and fees billed by Permit America, Inc. Secondary cards will only be charged if the primary card is not approved for payment. Permit America will only allow two credit cards on file. Please call (866) 573-7648 with any questions. I understand that Permit America will Pre-Authorize my credit card upon ordering routes. I understand that this Pre-Authorization will be removed from my billing statement within 72 hours upon completion of my invoice. My credit card will then be charged for the full amount of the invoice, including a 4% convenience fee. I hereby authorize Permit America to charge my credit card account. Please fax completed form to (866) 706-5766 or scan and email to permits@permitamerica.com
  • BILLING INFORMATION (AS IT APPEARS ON YOUR CREDIT CARD STATEMENT)

  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Permit America For Your Mobile Device

You can now carry digital copies of all of the provision sheets on your favorite Android or iOS device using our new app!

Permit America Android Device Mobile App
Permit America IOS Device Mobile App