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Print form                    Clear form                  TC-894
Recurring Credit Card Charge Authorization                                                                                                        Rev. 5/04
Company name                                                                                                   Dealer number


Card holder's name                                                                                             Card holder's telephone number


                                                                                                               Card holder's email address
Billing address


City                                                                                                           State                  ZIP code


Card type (Check one)                                                                                          DMV accounts receivable number

                                                                                  American Express
                          Visa                                 Discover
                                         MasterCard

Card number                                                                                                    Expiration date (mo./yr.)


                                                                                                              Date this authorization expires
This authorization will expire on the expiration date for this credit card, unless you want to terminate
this authorization sooner. If you want to terminate this authorization sooner, provide a date for expiration.

I authorize the Division of Motor Vehicles to automatically charge my credit card account, shown above, for the legal payable amount
allowed for services provided. I understand that any payments are based on the current legal price information available, during the
registration process.

My right to use this service is subject to any limits established by my credit card issuer. It is my responsibility to update the credit card
information that is used to pay for this service. I understand that I may notify the Division of Motor Vehicles by written request at anytime to
terminate this authorization.

The Division of Motor Vehicles reserves the right to charge this account without requiring the customer's signed authorization for each
transaction. Also, the Division of Motor Vehicles reserves the right to terminate this authorization agreement at anytime.
Card holder's signature (read statement above)                                                                 Today's date



                                                                                                                       Get forms online - tax.utah.gov

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tax.utah.gov forms current tc tc-894

  • 1. Print form Clear form TC-894 Recurring Credit Card Charge Authorization Rev. 5/04 Company name Dealer number Card holder's name Card holder's telephone number Card holder's email address Billing address City State ZIP code Card type (Check one) DMV accounts receivable number American Express Visa Discover MasterCard Card number Expiration date (mo./yr.) Date this authorization expires This authorization will expire on the expiration date for this credit card, unless you want to terminate this authorization sooner. If you want to terminate this authorization sooner, provide a date for expiration. I authorize the Division of Motor Vehicles to automatically charge my credit card account, shown above, for the legal payable amount allowed for services provided. I understand that any payments are based on the current legal price information available, during the registration process. My right to use this service is subject to any limits established by my credit card issuer. It is my responsibility to update the credit card information that is used to pay for this service. I understand that I may notify the Division of Motor Vehicles by written request at anytime to terminate this authorization. The Division of Motor Vehicles reserves the right to charge this account without requiring the customer's signed authorization for each transaction. Also, the Division of Motor Vehicles reserves the right to terminate this authorization agreement at anytime. Card holder's signature (read statement above) Today's date Get forms online - tax.utah.gov