Free Fax Filing Authorization Form.PDF - Texas

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