Case #: Case Name: Card #: 16-digit credit card number Expiration Date: 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 Amount to be Charged: $ Visa MasterCard American Express Only Visa, MasterCard and American Express are accepted.Billing Address: Street City State ZIP Cardholder Name: Daytime Phone #: ( ) Date: Cardholder Signature: For Office Use Only Clerk222s name if payment processed telephonically SDSC ADM-253 (Rev. 10/18) CREDIT CARD PAYMENT (CONFIDENTIAL) SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CREDIT CARD PAYMENT (CONFIDENTIAL) American LegalNet, Inc. www.FormsWorkFlow.com