PLEASE READ THE FORM CAREFULLY. This form MUST BE TYPED and can be completed on-line at our website.1 Press the tab key to advance to each field. IMPORTANT: The cardholder must notify the court if a card has been canceled or stolen. This form will remain in effect until the expiration date or until it is specifically revoked in writing. A new form must be submitted to the court upon any change to card or form information (e.g., cardholder name, authorized users, expiration date). Questions regarding this form should be addressed to Customer Service at 505-348-2500 or toll free 866-291-6805. A SIGNATURE IS REQUIRED. UNITED STATES BANKRUPTCY COURT - DISTRICT OF NEW MEXICO CREDIT CARD BLANKET AUTHORIZATION FORM I, as Cardholder, authorize the United States Bankruptcy Court for the District of New Mexico to charge the credit card listed below for payment of fees, costs and expenses incurred by the authorized users listed below, and I understand that the Clerk’s Office will automatically charge the account. (1). Cardholder name AS IT APPEARS ON THE CARD: CARDHOLDER SIGNATURE: E-mail address (required): (2). Date signed: Phone: NAMES OF AUTHORIZED USERS. If applicable, include the cardholder name as an authorized user. Type names of all authorized users on the appropriate line below (i.e., attorney or non-attorney). Atty: Atty: Atty: Atty: Atty: Atty: Non-atty: Non-atty: Non-atty: (3). CARD TYPE: MasterCard (4). Visa Discover American Express ACCOUNT NUMBER: Diners Club EXPIRATION DATE: (Include spaces as shown on card) (5). If authorized users listed above may charge to more than one credit card with a blanket authorization on file, check the order for usage here. This card: (6). CHECK HERE First Second Third if you want us to mail receipts and charge slips to you. Enter the mailing address: . If you do not enter an address, the Clerk’s Office will place receipts in the filer’s pick-up box or mail them to the address on filed papers. (7). Sign and date the form. Forms submitted without the cardholder’s signature or date signed will be returned unprocessed. Mail, fax2 or hand-deliver this form to U. S. Bankruptcy Court District of New Mexico 500 Gold Avenue SW, 10th Floor (PO Box 546) Albuquerque NM 87103-0546 1 The court’s website address is http://www.nmcourt.fed.us/web/BCDOCS/bcindex.html. Click on C OURT FORMS. 2 To fax the form, contact the Clerk’s Office at 505-348-2500 or toll free 866-291-6805 for the fax number. FORM 9 K:\_WEB\public\Files\forms\form9.wpd revised 07-05-2005 American LegalNet, Inc. www.FormsWorkflow.com