New Mexico > Federal > Bankruptcy Court
Credit Card Blanket Authorization Form 9 - New Mexico
| Credit Card Blanket Authorization Form Form. This is a New Mexico form and can be used in Bankruptcy Court Federal . |
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INSTRUCTIONSFOR COMPLETING FORM : This form must be typed and can be completed on-line via our website www.nmcourt.fed.us/web/BCDOCS/bcindex.htm. Select Court Forms . Press the tab key to advance to each field. A new form must be submitted to the court upon any change to name of cardholder, authorizedusers, or other form information. The cardholdermust notifythe court if a card has been canceled or stolen. This form will remain in effect until the expiration date or until it is specifically revoked in writing. Asignature is required. The clerks office will place receipts in the filers pick-up box or mail them to the address on filed papers. Questions regarding this form should be addressed to Customer Service at 505-348-2500 or toll free 866-291-6805. UNITED STATES BANKRUPTCY COURT - DISTRICT OF NEW MEXICO CREDIT CARD BLANKET AUTHORIZATION FORM I authorizethe United States Bankruptcy Court for the District of New Mexicoto charge the credit card listed belowfor paymentof fees, costs and expenses incurred by the authorizedusers listed below, and Iunderstand that the Clerks Office will automatically charge the account. Cardholder name as it appears on the card: Signature: Date of Authorization: Address: Phone: NAMES OF AUTHORIZED USERS: Use CURSOR to select card type: MasterCard Visa Discover American Express Diners Club ACCOUNT NUMBER: EXPIRATION DATE: If authorized users listed above may charge to more than one credit card with a blanket authorization on file, check the order for usage here. This card (use CURSOR): First Second Third Sign and date the form . Forms submitted without the cardholders signature or date authorized will be 1 returned unprocessed. Mail or hand-deliver the form to United States Bankruptcy Court District of New Mexico ATTN: Customer Service Counter th 500 Gold Avenue SW, 10 Floor PO Box 546 Albuquerque NM 87103-0546 1 To fax the form, first contact Customer Service in the Operations Department at 505-348-2500 or toll free 866-291-6805. F:\ALL FORMS\pdf fillable forms\cred card blanket auth.wpd FORM 9 as of 05/21/2004 per MGG
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