COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : United States Bankruptcy Court, Western District Index No. of Texas CREDIT CARD BLANKET AUTHORIZATION FORM : Calendar No. INSTRUCTIONS: This form is available on the Court Web site at www.txwb.uscourts.gov. You may fill-in and then print the : electronic form (tab between fields) OR you may print the form and complete with a typewriter. JUDICIAL SUBPOENA Plaintiff(s) This is a -against- : F new F amended authorization. q Registered Attorney Bar ID #: Registered Attorney Name: : Attorney Law Firm Name: : Defendant(s) : Attorney Business . . . . . . .Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mailing . . . . . . Voice PhonePEOPLE OF THE STATE OF NEW YORK THE Number: FAX Phone Number: Credit TO Cardholder Name as it appears on the card: Credit Cardholder Address if different than Attorney Address: GREETINGS: CREDIT CARD INFORMATION American Credit Card Expiration WE COMMAND YOU, that Diners all business and excuses being laid aside, you and each of you attend before Express Discover Club Number Date (mm/yy) , at the Court located at County of q F room F F the Fday of F in , on , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Mastercard Visa the Honorable F q F F F F F F F F F q Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Please the party on whose behalf thislocation(s) where you will be maximum penalty of $50 and all damages sustained as a check only the divisional office subpoena was issued for a filing electronically. result ‘ El Paso ‘ Midland ‘ San Antonio ‘ Waco ‘ Austin of your failure to comply. I am empowered to sign this form on behalf of my law firm and hereby authorize the U S. Justices of the Witness, Honorable , one of the Bankruptcy Court for the Western District of Texas County, the creditof to charge card(s) listed above for payment of filing fees for electronic filings by Court in day , 20 the attorney named above. I understand that if any charges against this/these credit card account(s) are denied, the court will notify the registered attorney to arrange for immediate payment of the fee. Date: Credit Cardholder Signature (Attorney must sign above and type name below) This authorization will be secured in the Bankruptcy Clerk’s office and will remain in effect until the expiration date of the card or specifically revoked in writing. It is the responsibility of the cardholder to submit an amended form to notify the court of any changes of attorney information, cardholder information, and/or card expiration dates. The cardholder is also responsible for notifying the court in writing if a creditAttorney(s) for card has been revoked, canceled or stolen. When completed , attach a legible copy of the FRONT of the listed credit card(s) and mail to: Registration Desk, U.S. Bankruptcy Court P.O. Box 1439 San Antonio, TX 78295-1439 Court Use Only: Received: __________ Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Verified by: __________ Date Processed: __________ [form date 03/01/2001] American LegalNet, Inc. www.USCourtForms.com