Court Account Authorization Form {MISC28}

COURT ACCOUNT AUTHORIZATION FORM The attached filings should be paid with the following Court Account to pay the attached filings. Court Account #: ______________________________________________________ Court Account Name: __________________________________________________ Telephone Number: ____________________________________________________ Form 50 Agent Name: ______________________ Form 50 Agent #______________ By signing this form, I authorize the above referenced Court Account to be debited. Form 50 Agent Signature: _______________________________________________ (date) MISC 28 ­ 06/05/2007 American LegalNet, Inc. www.FormsWorkflow.com