UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO OFFICE OF THE CLERK Alfred A. Arraj United States Courthouse 901 19th Street, Room A105 Denver, Colorado 80294-3589 303-844-3433 / Fax: 303-335-2040 CREDIT CARD COLLECTION NETWORK The District of Colorado accepts Visa, MasterCard, American Express, Discover and Diners Club credit cards. A credit card may be used for various types of payments, including filing fees, copy work and criminal debt payments. It can be used for one transaction, or, upon submission of an authorization form as referenced below, may be used upon your request. A law firm may complete a credit card “Authorization Form” (Attachment 1) which could be used for multiple transactions. The completed form would be sent to the Financial Department of the Clerk’s office, who will maintain the credit card information in a secure place. Upon the filing of a new complaint, notice of removal, or other filing requiring a fee, and your authorization by e-mail to use the credit card, the Financial Department would process your payment. See our Electronic Case Filing Procedures (ECF) for further details. You may also authorize use of the credit card for other payments, such as payments for copies, certificates of good standing, etc. Individual credit card payments may be made via the telephone, by mail or by e-mail. The amount of the payment, reason for the payment, your name as listed on the credit card, credit card billing address, credit card number, the V-CODE on the back of the card, expiration date and other miscellaneous information must be given to the deputy clerk. For more information, contact the Financial Department at 303-335-2053. Rev. 06/11 American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO 901 19th Street, Room A105 Denver, Colorado 80294-3589 303-844-3433 / Fax: 303-335-2040 CREDIT CARD COLLECTION NETWORK AUTHORIZATION FORM ________________________________________ (Name of Company/Firm) hereby authorizes the United States District Court for the District of Colorado to charge the following bank credit card number for payment of filing fees and other court-related expenses. Please Print Credit Card Information: Name on Card: _______________________________________________________________________ Billing address: _______________________________________________________________________ City ________________________ State: ______ Zip Code: ____________ Type of Card: _____________ Card #: _________________________________________________ V-CODE (3 or 4 digit security code on front or back of card) __________ Exp. Date: ___________ E-mail Address: ______________________________________ Phone Number: _________________ This form, which will be kept on file in the Clerk's Office, shall remain in effect until specifically revoked in writing. It is the responsibility of the company/firm named herein to notify the Clerk's Office of change in authorized users, the new expiration date when a credit card has been renewed, or if a credit card has been cancelled or revoked. Approved by: (Signature) __________________________________________ Date: __________________________________________ (Print Name) ____________________ Additional Authorized Users: (Please check only ONE box below) G In addition to the signer above, only those listed below are authorized to use this credit card (Use additional page if necessary): Name: ________________________________ Signature: _____________________________ Name: ________________________________ Signature: _____________________________ G Any person filing on behalf of the above listed company/firm, may authorize use of this credit card to pay the fee. Attachment 1 Rev. 06/11 American LegalNet, Inc. www.FormsWorkFlow.com