United States Bankruptcy Court Western District of Michigan Gerald R. Ford Federal Building PO Box 3310 Grand Rapids, MI 49501 Mark Van Allsburg Clerk (616) 456-2693- Tel. (616) 456-2919- Fax. CREDIT CARD PAYMENTS FOR COURT SERVICES The bankruptcy court will permit payment for court fees and services using VISA or MASTERCARD credit cards. In all cases, requests for services and charges to the credit cards must be in writing. Here’ how it will work: s Blanket authorizations: Law firms, partnerships, professional corporations and sole practitioners may file a blanket authorization with the court which will permit any lawyer associated with the firm and any employee of the firm to request services and to charge a specified credit card for those services. Requests for fees or services to be charged must be made in writing but need not be made on a specific form. The authorization will also allow the court to charge the credit card account once a month for any charges incurred against the monthly account of the firm. It will be assumed that this is the preferred method of payment for such accounts unless we are notified otherwise. A form blanket authorization is attached. One time authorization: Lawyers and other employees of law firms may charge fees or costs to a credit card using the one time authorization form. Only the person whose signature appears on the back of the credit card will be permitted to request payment using a credit card. In all cases, such requests must be made on our form and a photocopy of both sides of the card must be attached. Receipts: Cash register receipts will be returned to persons making payment by credit card. Further questions about credit card payments should be addressed to Julie McMahon. She can be reached at (616) 456-2902. 2000 © American LegalNet, Inc. United States Bankruptcy Court Western District of Michigan Gerald R. Ford Federal Building PO Box 3310 Grand Rapids, MI 49501 CREDIT CARD AUTHORIZATION FORM BLANKET AUTHORIZATION I hereby authorize the the United States Bankruptcy Court for the Western District of Michigan to charge the credit card noted below for payment of fees, costs and expenses which are incurred by myself or any member or employee of the law firm, partnership or professional corporation stated below. I certify that I am authorized to sign this form on behalf of my law firm. I understand that charges will be made only upon written request but that copies or other charges recorded by employees or runners who request copies at the court and in person may be made against the firm’ monthly account with the court. s Name: __________________________________ Signature: __________________________________ Date:___________________ Law Firm Name:_______________________________________________________________ (If sole practitioner write in your name) Address: ______________________________________________________________________ ______________________________________________________________________ Name of Person to whom receipts should be sent:_____________________________________ Telephone Number:_____________________________________________________________ VISA Account No. ____________________________ Expiration Date:________________ MASTERCARD No. __________________________ Expiration Date: _______________ ? Please pay for any charges to this firm’s monthly account by charging them to this credit card and sending the firm an intemized statement and receipt at the end of each month. ? Please do not pay the firm’s month account by using this credit card. We will send you a check within 10 days when billed. This form will be kept on file in the Clerk’ office and will remain in effect until specifically s revoked in writing. It is the responsibility of the law firm named above to notify the court of a new expiration date when a credit card has been renewed or to notify the court if the card has been revoked, cancelled or stolen. United States Bankruptcy Court 2000 © American LegalNet, Inc. Western District of Michigan Gerald R. Ford Federal Building PO Box 3310 Grand Rapids, MI 49501 CREDIT CARD AUTHORIZATION FORM ONE TIME AUTHORIZATION Case Name:________________________________ Case Number:______________________ I hereby authorize the United States Bankruptcy Court for the Western District of Michigan to charge the credit card account noted below for payment of the fees, costs or expenses which are listed below. I certify that I am a person who is authorized to use this credit card. This form must be signed by the person whose signature appears on the back of the credit card. Name: _________________________________________________________________ Address: Signature: _________________________________________________________________ __________________________________ Date:___________________ Daytime telephone #: ______________________ Fax # _____________________________ Information about card: VISA No. _____________________________________ Expiration Date:______________ MASTERCARD No. ____________________________ Expiration Date:______________ Information about the charge: Please check the appropriate box and the amounts: Filing Fees (for new cases) $ ______________ Motion Fees $ ______________ Conversion fee $ ______________ Search fee (all credit card requests) $ ______________ Copies and certificates $ ______________ Appeal fee $ ______________ File Retrieval from Archives $ ______________ Other: ________________________________________ $ ______________ Total Charge $ ______________ You must photocopy your credit card (both sides) and attach the copy to this form. 2000 © American LegalNet, Inc.