Free CUSTOMER ORDER FORM FOR COPIES - Texas

CUSTOMER ORDER FORM FOR COPIES $1.00 Per Page For All Copies NO PERSONAL CHECKS ACCEPTED
ATM available at 1201 Franklin, 1st Floor

TO BE COMPLETED BY THE CUSTOMER (PLEASE PRINT) CUSTOMER #____________ CAUSE NUMBER: _______________________________________ STYLE: ________________________________________________ VS. _______________________________________________ NEED COPY OF: PLEASE CHECK PETITION DATE OF FILING: ____________________________ DECREE/JUDGMENT DATE OF DECREE/JUDGMENT: _______________ ORDER DATE OF ORDER: ____________________________ OTHER, PLEASE SPECIFY: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ PLEASE SPECIFY: ( ) CERTIFIED or ( ) UNCERTIFIED

NUMBER OF COPIES: _______ NUMBER OF COPIES: _______ NUMBER OF COPIES: _______ NUMBER OF COPIES: _______ NUMBER OF COPIES: _______ NUMBER OF COPIES: _______ NUMBER OF COPIES: _______

CUSTOMER'S NAME (Please Print): ___________________________________________________________________________ ATTORNEY'S BAR NO. ________________________ LAW FIRM'S I.D. NO: _________________________________________ PHONE NUMBER: __________________________________________________________________________________________ ADDRESS: _________________________________________________________________________________________________ Indicate Form of Payment: CASH: _________________________________________
Amount Given To Clerk

If tendering cash, indicate Payor's Name you wish to be reflected on receipt:_______________________________________ CREDIT CARD: ______________________
Credit Card Type

Name on Credit Card: ___________________________________ Number: ____________________________

MONEY ORDER/CASHIER'S CHECK Type: ______________

FOR DISTRICT CLERK'S OFFICE USE ONLY Court: _______________________________________________________ Order Taken By: ________________________________________________ Total Number Of Pages/Screens: ______________________________________ Date: ___________________________________________________________

Number Of Screens Printed/Verified By: ______________________________________________________________________________________________________ Transaction Number: ____________________________________________ Number Of Copies/Print-Outs:______________________________________ Volume/Page:_________________________ Frame/Roll:_______________________ Receipt Number: __________________________________________________ Number Of Pages/Screens Per Copy Print-Out: ____________________________ Imaged Number: ______________________________________________

SPECIAL INSTRUCTIONS: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________

Large Order, Customer to Return: ________________Date:

______________________Time: _____________________________

Revised 8/21/07