COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.UNITED STATES BANKRUPTCY COURTEASTERN DISTRICT OF LOUISIANAJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)CREDIT CARD COLLECTION AUTHORIZATION FORMWe hereby authorize the United States Bankruptcy Court for the Eastern District of Louisiana to charge the followingbank card numbers(s) for payment of filing fees and other court related expenses.Name as it appears on Card:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Name of Law Firm:Authorized users:THE PEOPLE OF THE STATE OF NEW YORK TOSignaturePrint/TypeSignaturePrint/TypeCredit Card Billing Address:GREETINGS:City:State:Zip Code:Telephone No.:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,Mailing Address:located at County ofCity:State:Zip Code:Telephone No.:o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomMaster Card No.:Exp. Date:Visa Card No.:Exp. Date:Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Exp. Date:Discover Card No.:Exp. Date:American Express No.:, one of the Justices of theExp. Date:Diners Card No.:Court in Witness, Honorableday of, 20 County,Contact person and telephone number, in the event that further information is required, e.g. verification of runner/courier's authority to charge to the above account:(Attorney must sign above and type name below)Name:Telephone number:This form will be kept on file in the clerk's office, and shall remain in effect until specifically revoked in writing. It is the responsibility of the firm/company named herein to provide written notification to the Clerk's Office if a card has been canceled or revoked. An updated Credit Card Collection Authorization Form must be filed when modification of the above information is necessary, including the expiration date when a card is renewed. Indicate if this information is: NEW [ ] or UPDATED [ ]Attorney(s) forOffice and P.O. AddressSignature:Date:*In the event that a charge against this account is denied, you will be notified immediately to make payment in cash, money order or certified check. This payment will be due immediately. Any abuse of this privilege will result in your removal from the credit program. All forms must contain original signatures.Telephone No.: Facsimile No.: E-Mail Address:Return completed form to the Financial Department, Attn. Mrs. Betty Smith, U.S. Bankruptcy Court, EDLA, 501 Magazine Street, New Orleans, LA 70130.Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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