T HE S TATE ALASKA American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com T HE S TATE ALASKA American LegalNet, Inc. www.FormsWorkFlow.com All major credit cards are accepted. For security purposes, do not email credit card information. Include this credit card payment form with your application. Name of Applicant or Licensee: Program Type: License Number : I wish to make payment by credit card for the following AMOUNT Application Fee: License or Renewal Fee: Other : 1.2. TOTAL: Name : Mailing Address: Phone Number: Email : Signature of Credit Card Holder: 08-4438 Rev 12/26/18 Credit Card Payment Form (all major cards accepted) State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing PO Box 110806, Juneau, AK 99811 Phone: (907) 465-2550 Credit Card Payment Form CREDIT CARD INFO: Your payment cannot be processed unless all fields are completed! All four fields MUST be completed! This section will be destroyed after the payment is processed. Account Number : Expiration Date: Billing ZIP Code: Security Code : FOR DIVISION USE ONLY T HE S TATE ALASKA of American LegalNet, Inc. www.FormsWorkFlow.com