home // Business and Economy // Credit Card
United States Bankruptcy Court - Northern District of Florida ...
Source: www.flnb.uscourts.gov
File Size: 150.55 KB
Category: Business and Economy
Last Download : 21 days 3 hours 49 minutes ago
Share this info:
Short Description: whose signature appears on the back of the credit card. If the card is not present, you must photocopyyour credit card (BOTH ...
Content Inside: INSTRUCT IONS FOR C OMPLET ING FORM : This for m must be type d. The signa ture field must b e sign ed by th e per son whose signature appears on the back of the credit card. If the card is not present, you must photocopy your credit card (BOTH SIDES) and attached the copy to this form. United States Bankruptcy Court - Northern District of Florida CREDIT CARD ONE TIME AUTHORIZATION FORM I hereb y author ize th e U.S. Bankr uptcy Cour t for th e Nort hern Dist rict of F lorid a to cha rge th e cred it car d lis ted b elow for payment of fees, costs, and expenses as designated on this form. I certify that I am authorized to use this credit card. The U.S. Bankruptcy Court will maintain this form in the court's safe. Credit Cardholder Name: Signature: Date: Address: Telephone Number: CARD TYPE: (Check card type below) ____ _ MasterCard ______V ISA _____Discover _____American Express* _____Diners Club **American Express ID Number __ ____ (T his four digit number is print ed on your card a bove the embossed account number.) Account Number: Exp. Date: CHARGE INFORMATION: Please list the appropriate amounts for each applicable char ge. Filing Fee (for new cases) $ Motion Fee $ Conversion Fee $ Sear ch Fee $ Copies and Certificates made by court $ Appeal Fee $ File Retrieval from Archives $ Compla int Fee $ Other: $ TOTAL CHARGES: $
Advertiser