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Payment Form 807 - Texas

Payment Form Form. This is a Texas form and can be used in Corporation Secretary Of State .
 Fillable pdf Last Modified 1/15/2015
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Payment Form (Revised 08/14) Date of Receipt (for office use). Please type or print clearly. (Expedited Handling Service is only available for Business Entity Filings.) Expedited Handling Requested? Yes No Fax: (required for expedited filings) ($25 per document/$10 for copies/certificates) PAYMENT Charge to Credit Card Card Type: Card No.: Name on Card: Credit Card Billing Address: City: Charge to Secretary of State Client Account No.: (filings require sufficient funds in client account) American Express ­ ­ ­ Discover Exp: MasterCard (MM/YY) Visa *Security Code: Phone: State: Zip Code: Name on Account: Charge to LegalEase Account No.: (For Information about LegalEase, call 800-253-5749) 500679 ­ Case No.: ­ ­ Client Reference No.: Fees paid by credit card are subject to a statutorily authorized convenience fee of 2.7% of the total fees incurred. Signature: Date: DOCUMENT TO BE FILED OR REQUEST FOR COPIES/CERTIFICATE (include name on document and SOS file number if applicable) REQUESTOR NAME & ADDRESS (IF DIFFERENT THAN PAYMENT INFORMATION) Do not complete this section if requesting Authentication Services Name: Street: City: Phone: * For Mastercard, Visa, and Discover, the Security Code is the last three digits in the signature area on the back of your card. For American Express, it is the four digits on the front of the card. American LegalNet, Inc. www.FormsWorkFlow.com State: Zip Code:
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