CARD CONSENT FORM

Credit/Debit Card Processing- Consent

This consent form is for the Office of Denair Community Services to retain your card information on file forthe customer to CALL and make a payment OVER THE PHONE.

If you want to sign up for AUTO PAYMENT please fill out the AUTO PAYMENT FORM on the pay online page.

Customer Name (required)

Service Address (required)

Account Number (required)

Email (required)

Phone Number (required)

Name on Card

Card Number

Card Expiration Date

CVC Number

Billing Zip Code

I will call the Denair Community Services Office on the day I would like my card processed. (required)

I agree

I, the credit card holder, consent to Denair Community Services District retraining the credit card information it obtains when I make a payment to the District by credit card; any use of the credit card to pay for any services or to make any purchase can only be done with the advance, further consent by the card holder. Credit card information retained by Denair CSD will be used only for payments to be made to the district, that the card holder has specifically consented to. Denair CSD will not disclose the card information or any information concerning the card holder to any third person, unless required by law. (required)

I agree

Convenience fee will be applied to payment by credit card processing company (Fees verify based off card type and amount) (required)

I agree

By typing my name below, I understand and agree that this form of electronic signature is the same as a manual signature (required)

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If you do not want to send your card information thru this form please call the office at 209-634-4986 or visit us in person at 3850 N Gratton Road Deniar CA 95316.

Website Accessibility Policy

Denair Community Services District is fully committed to providing accessible facilities, elements and channels of communication to all members of the public. As part of this commitment, Denair Community Services District has a policy of providing an accessible website compatible with the Web Content Accessibility Guidelines (WCAG 2.1) and commercial screen reading software. All features of the website are coded to allow individuals with vision and other impairments to understand and use the website to the same degree as someone without disabilities. We welcome feedback and can often resolve issues in a timely manner if they arise.

If you need any special assistance or accommodations:

Call us at 2096344986

Ongoing Compliance Information

Compliance Officer

Denair Community Services District has designated a compliance officer for website disability-related accommodations. The compliance officer has received training in website accessibility and updates the site in accordance with those best practices. Contact our accessibility officer to report an issue.

Compliance Procedures and Reports

In addition to testing with users with a wide range of disabilities and coding our website to WCAG standards, Denair Community Services District regularly scans its website to ensure ongoing compliance, and makes timely changes to any inaccessible changes, if any are found.

Linked Documents and Third Parties

Please note that this site may link out to third-party websites, such as state or federal agencies, that do not have accessible content. This site may also include documents provided by third parties included in our agenda packets, for example. While we cannot control the accessibility of content provided by third parties, we are happy to assist any member of the public with reading and accessing content on our site.

See an opportunity for us to improve? Please contact our accessibility officer or call us at 2096344986.

Report a Website Accessibility Issue

We are committed to your ability to access all content, and we will respond to all requests as soon as possible.