COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Index No. Calendar No. UNITED STATES BANKRUPTCY COURT : EASTERNPlaintiff(s) OF LOUISIANA DISTRICT JUDICIAL SUBPOENA -against- : CREDIT CARD COLLECTION AUTHORIZATION FORM : We hereby authorize the United States Bankruptcy Court for the Eastern District of Louisiana to charge the following : bank card numbers(s) for payment of filing fees and other court related expenses. Defendant(s) : Name. as .it. appears .on Card: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....... ....... Name of Law Firm: Authorized users: OF THE STATE OF NEW YORK THE PEOPLE Signature Print/Type Signature Print/Type TO Credit Card Billing Address: GREETINGS: City: State: Zip Code: Telephone No.: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Address: Honorable at the Court Mailing located at County of , on the day , 20 , o'clock in the noon, City:in room State: of Zip Code:at Telephone No.: and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Master Card No.: Exp. Date: Visa Card No.: Exp. Date: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Discover Card No.: the party on whose behalf this subpoena was issued for a maximum penaltyExp. Date: all damages sustained as a of $50 and result of your failure to comply. Exp. Date: American Express No.: Witness, Honorable Court in County, Diners Card No.: , one of the Justices of the Exp. Date: day of , 20 Contact person and telephone number, in the event that further information is required, e.g. verification of runner/courier’s authority to charge to the above account: Name: (Attorney must sign above and type name below) Telephone number: This form will be kept on file in the clerk’s office, and shall remain in effect until specifically revoked in writing. It is the responsibility of the firm/company named herein to provide written notification to thefor Attorney(s) Clerk’s Office if a card has been canceled or revoked. An updated Credit Card Collection Authorization Form must be filed when modification of the above information is necessary, including the expiration date when a card is renewed. Indicate if this information is: NEW [ ] or UPDATED [ ] Office and P.O. Address Signature: Date: *In the event that a charge against this account is denied, you will be notified immediately to make payment in cash, money order or certified check. This Telephone No.: payment will be due immediately. Any abuse of this privilege will result in your removal from the credit program. Facsimile No.: All forms must contain original signatures. E-Mail Address: Return completed form to the Financial Department, Attn. Mrs. Betty Smith, U.S. Bankruptcy Court, EDLA, 501 Magazine Street, New Mobile Tel. No.: Orleans, LA 70130. American LegalNet, Inc. www.USCourtForms.com