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Credit Card Payment (Confidential) ADM-253 - California

Credit Card Payment (Confidential) Form. This is a California form and can be used in Administrative San Diego Local County .
 Fillable pdf Last Modified 8/19/2009
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CREDIT CARD PAYMENT (CONFIDENTIAL) Case #: Card #: 16-digit credit card number Case Name: Expiration Date: MasterCard Visa Security Code*: *The security code is a 3-digit number found on the reverse of the credit card near the signature panel and following the account number Only MasterCard and Visa are accepted. Amount to be Charged: $ Billing Address: Street City State ZIP Cardholder Name: Print name exactly as it appears on card Daytime Phone #: Cardholder Signature: ( ) For Office Use Only Date: Clerk's name if payment processed telephonically SDSC ADM-253 (Rev. 7/09) CREDIT CARD PAYMENT (CONFIDENTIAL) American LegalNet, Inc. www.FormsWorkFlow.com
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