Arkansas > Federal > USBC Eastern And Western
One Time Credit Card Authorization Form - Arkansas
| One Time Credit Card Authorization Form Form. This is a Arkansas form and can be used in USBC Eastern And Western Federal . |
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United States Bankruptcy Court - Eastern & Western Districts of Arkansas ONE TIME CREDIT CARD AUTHORIZATION FORM INSTRUCTIONS FOR COMPLETING FORM: This form must be typed and can be completed electronically on our website, www.arb.uscourts.gov/forms/ccauthfillable.pdf Press the tab key to advance to each field. A handwritten signature is required. This form must be faxed to 501-918-5520. I hereby authorize the U.S. Bankruptcy Court to charge the credit card listed below for payment of fees, costs, and expenses which are listed below. I certify that I am a person who is authorized to use this credit card. Credit Cardholder Name: Street, City, State, Zip Telephone Number: Email Address (optional): Signature: Fax Number: Date: CARD INFORMATION: Account Number Expiration Date: Card Type: CHARGE INFORMATION: Filing Fee Installment Fee Motion for Relief or Motion for Abandonment Conversion Fee Search Fee Copies Certification Appeal Fee Archived File Retrieval Adversary Fee Other Quantity Fee Amount Total Fees $176.00 $ 30.00 $ .50 $ 11.00 $ 53.00 $293.00 Total to be Charged Please list all debtor(s) and case number(s): 1. 2. 3. Reason for not paying online: Print Form American LegalNet, Inc. www.FormsWorkFlow.com
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