Front Counter BC payment form

This page is provided for information purposes only. To fill out a copy of this form, please download the PDF version and follow the instructions on the form for submission.

Protected B when completed

Credit card payment

Important notice

Credit card information cannot be accepted by email, fax or regular mail.

To process your credit card payment, please fill in the details below in order for FrontCounter BC to contact you to complete the transaction.

Please see FrontCounter BC Payment Guidelines for more information.

Your application will not be processed until we have received payment.

Company / organization

First name

Last name

Amount

Payment purpose

Regional ITC #

Phone number

Comments (best time to call, alternate phone number, etc.)

Do not include your credit card number on this form.

FrontCounter BC will contact you to obtain payment details to complete your credit card transaction.

Office use only

Client #

Tracking #

Date modified:: 2022-12-23

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Front Counter BC payment form

Credit card payment

Important notice

Office use only