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Credit Card Authorization Form For Criminal Debt Payments - South Carolina
|Credit Card Authorization Form For Criminal Debt Payments Form. This is a South Carolina form and can be used in General District Court Federal .||
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UNITED STATES DISTRICT COURT DISTRICT OF SOUTH CAROLINA CREDIT CARD AUTHORIZATION FORM FOR CRIMINAL DEBT PAYMENTSI hereby authorize the United States District Court for the District of South Carolina to charge the creditcard listed below for payment of criminal debt related expenses upon my request via telephone. Credit Cardholder Name:_________________________________________________________Address:________________________________________________________________ ______Telephone Number:_____________________________ Fax Number:_____________________Drivers License Number:_________________________ Drivers License State:____________Signature:__________________________________________ Date:___________ _________Card Type (Visa, Mastercard, Discover, American Express, Diners Club):_________________Card Number:_________________________________________________________________Expiration Date:________________ Mail the original of this form to: United States District Court Attn: Larry Long, Financial Administrator 901 Richland Street Columbia, SC 29201 Note: A copy of the cardholders drivers license or other identif ication along with a copy ofboth sides of the referenced credit card must be returned with this form.This form will be stored in the courts vault and will remain in effect until the cardholderspecifically revokes it in writing. It is the responsibility of the cardholder named above to submit a new form and notify the courtwhen: 1) the credit card has been renewed resulting in a new expiration date; and 2) a card hasbeen revoked, canceled, or stolen. To charge a criminal debt payment to your credit card, call our Columbia office at (803) 253-3137.