One Time Credit Card Authorization Form
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One Time Credit Card Authorization Form. This is a Arkansas form and can be use in USBC Eastern And Western Federal.
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Tags: One Time Credit Card Authorization Form, Arkansas Federal, USBC Eastern And Western
United States Bankruptcy Court 226 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. Based on the Administrative Office of the US Courts222 policy, copies from cases filed prior to December 1, 2003, will be provided via regular mail. 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: Fax Number: Email address(optional) Signature: Date: Card Information: Account Number: Expiration Date: Card Type: Charge Information: Quantity Fee Amount Total Fees Filing Fee Installment Fee Motion for Relief, Motion for Abandonment $1.00 Motion to Sell Property Free & Clear of Liens Under 11 U.S.C. 247363(f) $1.00 Conversion Fee Search Fee $ 3.00 Copies $ .50 Certification $ 11.00 Appeal Fee Archived File Retrieval (one box) $ 64.00 Archived File Retrieval (each add222l box) $ 39.00 Adversary Fee $.00 Other Total to be Charged Please list all debtor(s) and case number(s): 1.2. American LegalNet, Inc. www.FormsWorkFlow.com
