COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Plaintiff(s) -against- Calendar No. : JUDICIAL SUBPOENA : UNITED STATES DISTRICT COURT : MIDDLE DISTRICT OF GEORGIA : CREDIT CARD AUTHORIZATION FORM Defendant(s) : ...................................................... (Name of Company/Firm) hereby authorizes the United States District for THE PEOPLE OF THE STATE OF NEW YORK the Middle District of Georgia to charge the credit card listed below for payment of filing fees and other court related expenses incurred by TO individuals listed below. I certify that I am authorized to sign the form on behalf of my firm. the Credit Cardholder Name:_________________________________________________________ GREETINGS: Address:______________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Telephone , the HonorableNumber:________________________ Fax Number:__________________________ at the Court located at County of inSignature:______________________________________ Date:__________________________ recessed room , on the day of , 20 , at o'clock in the noon, and at any or adjourned date, to testify and give evidence as a witness in this action on the part of the Card Type (Visa, MasterCard, Discover, American Express, Diners Club)__________________ Card Number:_________________________________________________________________ Expiration Date:___________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a INDIVIDUALS to comply. result of your failureAUTHORIZED TO USE ABOVE CREDIT CARD ACCOUNT ____________________________________ ____________________________________ Witness, Honorable ____________________________________ Court in County, day of Mail the original form to: , 20 ______________________________ ______________________________ , one of the Justices of the ______________________________ CLERK, UNITED STATES DISTRICT COURT POST OFFICE BOX 128 (Attorney must sign above and type name below) MACON, GA 31202 This form will be stored in the court’s vault for safekeeping purposes and will remain in effect Attorney(s) for until the cardholder specifically revokes it in writing. It is the responsibility of the cardholder and/or firm named above to submit a new form and notify the court when 1) authorized users change; 2) a credit card has been renewed Office and P.O. Address resulting in a new expiration date; and 3) a card has been revoked, canceled or stolen. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com