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Credit Card Blanket Authorization Form - New Mexico
| Credit Card Blanket Authorization Form Form. This is a New Mexico form and can be used in District Court Federal . |
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UNITED STATES DISTRICT COURT DISTRICT OF NEW MEXICO CREDIT CARD BLANKET AUTHORIZATION FORM I authorize the United States District Court for the District of New Mex ico to charge the credit card listed below for payment of fees, costs and expenses incurred by myself or any member or employee of the law firm, partnership or professional corporation who is listed below. (A photocopy of both sides of the credit card must be attached.) Cardholder Name: Type of card: MasterCard Visa Card Number: Expiration Date: Names of individuals authorized to use account number listed above for p ayment of fees, costs and expenses: Signature: Date: (Print/Type Name) Law Firm/Practitioner Name: Address: Telephone: Facsimile Telephone: This form will be kept on file in the Clerks Office and will remain in effect until specifically revoked in writing. It is the responsibility of the cardholder to submit a new form to notif y the Court of changes to authorized users, a changed expiration date when a credit card is renewed, or in th e event the card is revoked, canceled, or stolen.
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