North Carolina > Federal > USBC Eastern
Credit Card Authorization - North Carolina
| Credit Card Authorization Form. This is a North Carolina form and can be used in USBC Eastern Federal . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NORTH CAROLINA CREDIT CARD AUTHORIZATION FORM INSTRUCTIONS: Please type or print. Mail completed and signed form to: CONFIDENTIAL United States Bankruptcy Court Eastern District of North Carolina ATTN: FINANCIAL ADMINISTRATOR Post Office Box 2807 Wilson, NC 27894-2807" FIRM/COMPANY: Phone Number: Credit Card Type: Visa MasterCard Discover American Express Diners Club Card Holder Name: Credit Card Number: - - - Expiration Date: / (MM/YY) Credit Card Statement Mailing Address: (Please be sure to list the address where Street Address or P. O. Box the credit card company sends your state- ments). City, State & Zip I acknowledge that the above information is accurate and that I am an au thorized signer of the account. I hereby authorize the United States Bankruptcy Court for the Eastern District of North Carolina to charge the above credit card account for c ourt filing fees incurred by me, my firm or company. Date: Signature Print Name This form, which will be kept on file in the Clerks Office, shall re main in effect until specifically revoked in writing. It is the responsibility of the attorn ey/firm named herein to notify the Clerks Office, Financial Administrator, of the new expira tion date when a credit card has been renewed, or if a card has been canceled or revoked. American LegalNet, Inc. www.USCourtForms.com
|
|||||||
