:::::: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Calendar No.UNITED STATES BANKRUPTCY COURTJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)WESTERN DISTRICT OF LOUISIANACREDIT/DEBIT CARD BLANKET AUTHORIZATION FORMPlease indicate if information is:New [ ] Updated [ ]We hereby authorize the United States Bankruptcy Court for the Western District of Louisiana to charge thefollowing bank card number for payment of filing fees and other court related expenses.Name of Law Firm/Business: Employees Authorized to incur charges on behalf of the firm/business:THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:Credit card Billing Address:(Street, P.O. Box, Other)WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,(City, State, Zip Code)located at County ofo'clock in the day ofnoon, and at any recessed in room, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of theBusiness Fax:Business Telephone:CARD INFORMATIONYour 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.**ATTACH A PHOTOCOPY OF THE FRONT AND BACK OF THE CREDIT CARD TO THIS APPLICATION**ACCOUNT NUMBER:EXPIRATION DATE:, one of the Justices of theMaster CardVisaDiscoverAmerican ExpressDinersCourt in Witness, Honorableday of, 20 County,Name as it appears on Card:Signature of Cardholder(Attorney must sign above and type name below)DateTerms/Conditions: In the event that charges against this account are denied, you will be notified immediately to make payment in cash, money order or check. This payment will be due immediately upon notification. Any abuse of this privilege will result in your removal from the credit program. All forms must contain original signatures.Attorney(s) forThis 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 cancelled or revoked. An updated Credit/Debit Card Blanket Authorization Form must be filed when modification of the above information is necessary, including the expiration date when a card is renewed.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Please return completed form to the following address:United States Bankruptcy Court United States Court House 300 Fannin St., Suite 2201 ATTN: FINANCIAL DEPT. Shreveport, LA 71101Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comFOR OFFICIAL COURT USE ONLYDate:Approved by:
|
Get this form for FREE as a print-only pdf
