If you want more information about this you may call or write any Social Security Office. FORM SSA-714 07-2005. YOU CAN MAKE YOUR PAYMENT BY CREDIT CARD As a convenience we offer you the option to make your payment by credit card. However regular credit card rules will apply. You may also pay by check or money order. We Honor Most Major Credit Cards Please fill in all the information below and return it with your request. Note Please read Privacy Act Notice CHECK ONE ---------------------------------------------- MasterCard Visa American Express Discover Diners Card Credit Card Holder s Name ---------------------------- Print First Middle Initial Last Name Number Street City State Zip Code Daytime Telephone Number --------------------------- Area Code Amount Charged Telephone Number - Credit Card Number Credit Card Expiration Date Month Year Authorization DO NOT WRITE IN THIS SPACE OFFICE USE ONLY --------------------------------------- Name Date PRIVACY ACT STATEMENT The Social Securi....
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How to fill out the SSA-714 online
Filling out the SSA-714 form is an essential step for users who wish to make a payment via credit card. This guide provides a clear and supportive approach to completing the form online, ensuring you understand each component and requirement.
Follow the steps to successfully complete the SSA-714 form.
- Press the ‘Get Form’ button to access the SSA-714 form and open it in the online editor.
- Indicate the credit card type by checking one of the options: MasterCard, Visa, American Express, Discover, or Diners Card.
- Enter the credit card holder’s name by providing the first name, middle initial, and last name in the designated field.
- Fill in the credit card holder’s address, including the number and street, city, state, and zip code.
- Provide a daytime telephone number, ensuring you include the area code for proper communication.
- Input the amount to be charged in the designated field, ensuring accuracy.
- Enter the credit card number in the appropriate section.
- Select the expiration date of the credit card, specifying the month and year.
- Sign the form in the space provided for the credit card holder’s signature to authorize the transaction.
- Review all entered information for correctness before you finalize your submission.
- Upon completion, you can save changes, download, print, or share the form as needed.
Take the first step and complete the SSA-714 form online today.
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