Chris Daniel Fax Filing Authorization Form Civil Intake Fax Number (713) 755-5480 Family Intake Fax Number (713) 755-5754 To Be Completed By The Customer (Please Print): CAUSE NUMBER: __________________________________ STYLE: __________________________________________ VS. ____________________________________________ CUSTOMER'S NAME (Please Print): _______________________________________________________________________ ATTORNEY BAR NUMBER:____________________________ LAW FIRM I.D. NUMBER: ________________________ ADDRESS: ___________________________________________________________________________________________ ATTORNEY’S PHONE NO. ____________________________ ATTORNEY’S FAX NO. __________________________ ATTORNEY’S EMAIL ADDRESS: ________________________________________________________________________ I hereby authorize the District Clerk to charge to my credit card for payment of the services requested above: CREDIT CARD TYPE: __________________________________________________________________________ CREDIT CARD NUMBER: ________________________________ DATE OF EXPIRATION: _______________ AUTHORIZED SIGNATURE: ____________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com