Form G-1450 Authorization for Credit Card Transaction

Authorization for Credit Card Transactions

USCIS
Form G-1450

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0131
Expires 01/31/2021

How To Fill Out Form G-1450
1.

Type or print legibly in black ink.

2.

Complete the "Applicant's/Petitioner's/Requester's Information," "Credit Card Billing Information," and "Credit Card
Information" sections and sign the authorization.

3.

Place your Form G-1450 ON TOP of your application, petition, or request package.

NOTE: Failure to provide the requested information may result in USCIS and your financial institution not accepting the payment.
USCIS cannot process credit card payments without an authorized signature.
NOTE: Form G-1450 may only be used with a form being submitted to a USCIS Lockbox. Do not submit this form to a USCIS
Field Office. They will not accept it.

DRAFT
Not for
Production
11/06/2018

We recommend that you print or save a copy of your completed Form G-1450 to review in the future and for your
records.

By completing this transaction, you agree that you have paid for a government service and that the filing fee, biometric services fee
and all related financial transactions are final and not refundable, regardless of any action USCIS takes on an application, petition or
request. You must submit all fees in the exact amounts.
Please refer to the form(s) you are filing for additional information, or you may call the USCIS Customer Contact number at
1-800-375-5283. For TTY (deaf or hard of hearing) call: 1-800-767-1833.

Applicant's/Petitioner's/Requester's Information (Full Legal Name)
Given Name (First Name)

Middle Name (if any)

Family Name (Last Name)

Credit Card Billing Information (Credit Card Holder's Name as it Appears on the Card)
Given Name (First Name)

Middle Name (if any)

Family Name (Last Name)

Credit Card Holder's Billing Address:
Street Number and Name
City or Town

Apt. Ste. Flr.

Number

State

ZIP Code

Credit Card Holder's Signature and Contact Information:
Credit Card Holder's Signature
Credit Card Holder's Daytime Telephone Number

Credit Card Holder's Email Address

Credit Card Information
Credit Card Number

Credit Card Expiration Date
(mm/yyyy)
Form G-1450 01/04/18

Credit Card Type:

Visa

Authorized Payment Amount

MasterCard

$

.00

American Express
Discover
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