Credit Card Authorization

To pay via credit card, please complete all the fields below.

For your convenience, the PBA offers a Mastercard/Visa credit card plan for payment of membership dues.

PBA Member ID:

Dues amount $:


Email:

Confirm Email:

A confirmation email will be sent to this address.

Phone Number:

Member Name:



Address:




Name as it appears on Credit Card:

Billing Address for Credit Card: (required if different - No PO Boxes accepted)




Check One:
VisaMastercard

Credit Card Number:

Exp. Date: (MM/YY)

CVS Code:


I accept these terms and conditions

Terms and Conditions

I hereby authorize the Florida Police Benevolent Association, Inc. (PBA), to charge the indicated credit card for monthly membership dues. I agree that this is a periodic charge that will be made on or around the 5th of each month. This Authorization shall remain in full force and effect until I cancel my billing agreement. To cancel, I must provide the request in writing to the PBA office via mail, email or fax 30 days prior to termination.

I understand that if I have any problems or questions regarding my agreement, I may contact the PBA for assistance. I agree that I will not dispute any valid charges unless I have already made an effort in good faith to rectify the situation directly, and those efforts have failed.

I guarantee and warrant that I am the legal cardholder for this credit card, and that I am legally authorized to enter into this agreement with the PBA.

Please check if this is a one-time payment.

Please check if this is a recurring payment.


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Security Code: (required)

By clicking here you are authorizing the PBA to complete your request to pay for your PBA dues through the credit card listed above.