Texas > Federal > Bankruptcy Court > Western District

On-Line Credit Card Fee Refund Request Form - Texas

On-Line Credit Card Fee Refund Request Form Form. This is a Texas form and can be used in Western District Bankruptcy Court Federal .
 Fillable pdf Last Modified 9/26/2006
Get this form for FREE as a print-only pdf

UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF TEXAS ON-LINE CREDIT CARD FEE REFUND REQUEST FORM I hereby request the U. S. Bankruptcy Court for the Western District of Texas to refund the credit card listed below for payment of fees paid in error via the CM/ECF on-line credit card payment system. CREDIT CARDHOLDER NAME: _______________________________________________ BILLING ADDRESS: ____________________________________________________ ____________________________________________________ ____________________________________________________ SIGNATURE: __________________________________________DATE:___________ DAYTIME TELEPHONE NUMBER:____________________ CARD INFORMATION: CARD TYPE ACCOUNT NUMBER EXP. DATE CM/ECF POSTED RECEIPT NUMBER AND DATE: _________________________ Attach a copy of the receipt printout given upon payment. AMOUNT TO BE REFUNDED $ CASE # BRIEF EXPLANATION FOR REFUND ____________________________________ ___________________________________________________________________ MAIL TO: or fax at U.S. BANKRUPTCY COURT ANNETTE ANDERSON, FINANCE P O BOX 1439 SAN ANTONIO, TX 78295 210-472-6215 FOR OFFICIAL COU RT US E ONLY APPROVED BY: DATE: American LegalNet, Inc. www.FormsWorkflow.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. fee waiver
  2. Petition to Expunge
  3. writ of replevin
  4. Income and Expense Declaration
  5. proof of claim
  6. divorce forms
  7. MOTION for continuance
  8. form interrogatories
  9. abstract of judgment
  10. Affidavit of Indigency

Bookmark and Share