Free Fax Filing Authorization Form.PDF - Texas

File Size: 56.6 kB
Pages: 1
Date: November 13, 2008
File Format: PDF
State: Texas
Category: Court Forms - Local
Word Count: 106 Words, 1,364 Characters
Page Size: Letter (8 1/2" x 11")

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Loren Jackson
Harris County District Clerk

Civil Bureau Fax Filing Authorization Form Civil Intake Fax Number (713) 755-5480 Family Intake Fax Number (713) 755-5754

To Be Completed By The Customer (Please Print):

CAUSE NUMBER: __________________________________ STYLE: __________________________________________ VS. ____________________________________________

CUSTOMER'S NAME (Please Print): _______________________________________________________________________ ATTORNEY BAR NUMBER:____________________________ LAW FIRM I.D. NUMBER: ________________________

ADDRESS: ___________________________________________________________________________________________ ATTORNEY'S PHONE NO. ____________________________ ATTORNEY'S FAX NO. __________________________

ATTORNEY'S EMAIL ADDRESS: ________________________________________________________________________

I hereby authorize the District Cle rk to charge to my credit card for payment of the services requested above:
CREDIT CARD TYPE: __________________________________________________________________________ CREDIT CARD NUMBER: ________________________________ DATE OF EXPIRATION: _______________

AUTHORIZED SIGNATURE: ____________________________________________________________________

S:\FormsLib\Civil Bureau\Civ Fam Intake & Customer Svc\Civintake\Fax Filing Authorization Form

Revised 10/1/99