Carbon County Clerk's Office
Business License
751 East 100 North, Suite 1100 - Price, UT 84501
VALYN.PEACOCK
@CARBON.UTAH.GOV
435-636-3227
Contact the clerks office prior to payment for exact amount.
Amount:
$
Item Subtotal:
$0.00
Business Account Number
[1]
Business Name
[1]
Business Account Number
[2]
Business Name
[2]
Business Account Number
[3]
Business Name
[3]
Business Account Number
[4]
Business Name
[4]
Business Account Number
[5]
Business Name
[5]
Business Account Number
[6]
Business Name
[6]
Business Account Number
[7]
Business Name
[7]
Business Account Number
[8]
Business Name
[8]
Business Account Number
[9]
Business Name
[9]
Business Account Number
[10]
Business Name
[10]
Total:
$0.00
Payer's Information
First Name:
Last Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Payment Information
Method of Payment:
Visa
MasterCard
Discover Card
Personal Checking
Personal Savings
Business Checking
Processing Fees:
Credit cards:
2.5% ($1.50 min)
(+1.5% processing fee for foreign cards)
eChecks:
$0.75
Update name from
Payer's Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number:
(Type number or swipe with cursor in this empty field)
Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
Cardholder Information
(exactly as it appears on your statement)
Update from
Payer's Information
Cardholder's Name:
Billing ZIP/Postal Code:
Please be aware that credit card payments will reflect on your statement as
Carbon UT 800-764-0844 Price UT
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