Form G-1450, Authorization for Credit Card Transactions Instructions
This form contains 28 fields organized into 8 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Applicant Full Legal Name | ||
| Applicant Family Name (Last Name) | Text |
Enter the applicant’s family name (last name) exactly as it appears on their legal documents.
|
| Applicant Given Name (First Name) | Text |
Enter the applicant’s given name (first name) exactly as it appears on their legal documents.
|
| Applicant Middle Name (if any) | Text |
Enter the applicant’s middle name exactly as it appears on their legal documents; leave blank if none.
|
| Authorized Payment Amount | ||
| Authorized Payment Amount | Number |
Enter the total dollar amount you authorize USCIS to charge to your credit card.
|
| Cardholder Billing Address | ||
| Street Number and Name | Text |
Enter the street number and name for the credit card holder’s billing address.
|
| Ste. | CheckBox |
Check this box if the cardholder's billing address includes a suite number.
|
| Apt. | CheckBox |
Check this box if the cardholder's billing address includes an apartment number.
|
| Flr. | CheckBox |
Check this box if the cardholder's billing address includes a floor number.
|
| Apartment, Suite, or Floor Number | Text |
Enter the apartment, suite, or floor number associated with the credit card holder’s billing address, if applicable.
|
| City or Town | Text |
Enter the city or town for the credit card holder’s billing address.
|
| State | ComboBox |
Enter the two-letter U.S. state abbreviation for the credit card holder’s billing address.
AS
TN
AR
SD
ND
DE
IA
ID
MA
ME
NM
CO
MT
WI
NY
GA
KS
AL
MI
VA
MN
CT
MD
OK
PW
WY
CA
FL
GU
HI
VT
MO
MS
NC
FM
MH
AP
DC
NE
NH
OH
NV
OR
UT
VI
SC
AK
PA
PR
AA
MP
AE
WA
RI
IN
AZ
TX
LA
WV
KY
NJ
IL
|
| ZIP Code | Text |
Enter the five-digit ZIP Code for the credit card holder’s billing address.
|
| Cardholder Full Name | ||
| Cardholder Middle Name | Text |
Enter the cardholder’s middle name or initial exactly as it appears on the credit card, if any.
|
| Cardholder Given Name | Text |
Enter the cardholder’s first name exactly as it appears on the credit card.
|
| Cardholder Family Name | Text |
Enter the cardholder’s last name (surname) exactly as it appears on the credit card.
|
| Cardholder Signature and Contact Information | ||
| Credit Card Holder's Daytime Telephone Number | Text |
Provide the cardholder’s daytime telephone number where USCIS or your financial institution can contact you regarding this transaction.
|
| Credit Card Holder's Email Address | Text |
Provide the cardholder’s email address where USCIS or your financial institution can send confirmations or inquiries about this transaction.
|
| Credit Card Holder's Signature | Text |
Sign or type the cardholder’s full name as it appears on the credit card to authorize this transaction.
|
| Credit Card Details (Number and Expiration) | ||
| Credit Card Number – Segment 1 | Text |
Enter the first four digits of the credit card number.
|
| Credit Card Number – Segment 2 | Text |
Enter the next four digits of the credit card number.
|
| Credit Card Number – Segment 3 | Text |
Enter the third group of four digits of the credit card number.
|
| Credit Card Number – Segment 4 | Text |
Enter the final four digits of the credit card number.
|
| Credit Card Expiration Date | Date |
Enter the expiration date of the credit card in the format mm/yyyy.
|
| Credit Card Type Selection | ||
| Visa | CheckBox |
Check this box if the credit card being used is Visa.
|
| MasterCard | CheckBox |
Check this box if the credit card being used is MasterCard.
|
| American Express | CheckBox |
Check this box if the credit card being used is American Express.
|
| Discover | CheckBox |
Check this box if the credit card being used is Discover.
|
| USCIS Internal Use | ||
| USCIS Internal Use Control Number | Text |
Enter the internal reference or control number assigned by USCIS for processing this form.
|