Donna Kay McKinney Bexar County District Clerk DISCOVER CARD AUTHORIZATION FORM Please Print or Type Discover/Novus Account Information Cardholder Name:_______________________________ Firm:______________________________________ Discover Account # ___ ___ ___ ___ - ___ ___ ___ __ - ___ ___ ___ ___ -_________Exp. Date:_____________ Telephone #:________________________________ Fax Phone #:________________________________ Authorized Signature:_______________________________________ _____________________________________________________________________________________________ FOR CLERK USE ONLY _____________________________________________________________________________________________ CAUSE #:_________________________________ COURT # ______________________________ STYLE: ___________________________________VS.____________________________________ TRANSMITTAL FEE $5.00 $1.00 PAGE x ____PGS $ COURT COSTS $ COPIES $ TOTALS $____________________________________________________________________________________ DATE POSTED INTO CASH SYSTEM:________________________RECEIPT #:______________________ FAX FILING PAYMENT PROCESSED COURT COSTS PAYMENT PROCESSED / / / BY___________AUTHORIZATION #:_____________ / BY__________AUTHORIZATION #:_____________ NOTES____________________________________________________________________________________ __________________________________________________________________________________________ THANK YOU FOR FAX FILING, IF YOU HAVE QUESTIONS PLEASE CALL (210) 335-2621 American LegalNet, Inc. www.FormsWorkFlow.com