Massachusetts > Federal > District Court
Request For Credit Card Payment Via Telephone-Mail - Massachusetts
| Request For Credit Card Payment Via Telephone-Mail Form. This is a Massachusetts form and can be used in District Court Federal . |
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Clerk, US District Court District of Massachusetts 1 Courthouse Way, Suite 2300 Boston, MA 02210 (617) 748-9143 (cashier) (617) 748-9096 (fax) Attention: Cashier Request for Credit Card Payment via Telephone/Mail Visa MasterCard Discover Diners Card Expiration Date Credit Card Number American Express Expiration Date Credit Card Number Four Digit ID# for American Express Purchase Amount Name as it appears on Card: Billing Address: Do Not Use a PO Box $ (Exact Amount or Not to Exceed) City Contact Name: Telephone Number: Authorized Signature: Printed Name of Signer: State Zip Code Reason for Payment: American LegalNet, Inc. www.USCourtForms.com
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