Ohio > City (Municipal Court) > Bowling Green > Traffic
Visa Mastercard Authorization Form - Ohio
| Visa Mastercard Authorization Form Form. This is a Ohio form and can be used in Traffic Bowling Green City (Municipal Court) . |
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VISA/MASTERCARD AUTHO RIZATION FORM I hereby authorize payment in the amount shown below to my VISA/MasterCard account. Case No. (if known) ____________________ Defendants name (please print _____________________) ___________________ I hereby authorize payment in the amount shown below to my VISA/MasterCard account. VISA/MASTERCARD Account Number Expiration Date Authorized Amount $ Phone Number (_______) _______________ Signature _____________________ ___________ Name of Cardholder ________________________________ (Please Print) FAX the completed form to (419) 352-9407, 24 hours a day. ADDITIONAL INSTRUCTIONS FOR PAYMENT OF A NE W TICKET: You must include a copy (front and back) of your signed ticket, and Proof of Insurance for traffic offenses (if not shown to the officer on the road). American LegalNet, Inc. www.USCourtForms.com
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