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CREDIT CARD TRANSACTION INFORMATION SHEET BY CLIENT

Attorney _____________________________________
Name: _______________________________________
Mailing Address _______________________________________
Mailing City/State/Zip: __________________________________

Name on Credit Card: ___________________________


Billing Address for Card: ______________________________________
Billing city State, Zip for Card : _________________________________
Credit card Number _____________________________________________
Security Code / CVVS __________________________
Expiration Date on CC: ______________ Type of Card: Visa Mastercard Discover
Amount to Charge: _________________________________________________
I hereby authorize the LAW OFFICES OF _______________ to charge the above
referenced card the amount of ____________________ for the fees of
__________________________________________________________ on this __________
day of _______________, 20_____. A copy of my card is attached.

___________________________________________________________________________
Authorized Signature

Brian S. Popp, 9-12-2011


CBA/CLE Getting Paid: Using Credit Cards at Your Solo or Small Firm

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CREDIT CARD TRANSACTION INFORMATION SHEET FOR THIRD


PARTY PAYMENT OF CLIENT ATTORNEY FEES AND COSTS
Attorney _____________________________________
Name: _______________________________________
Mailing Address _______________________________________
Mailing City/State/Zip: __________________________________

Name on Credit Card: ___________________________


Billing Address for Card: ______________________________________
Billing city State, Zip for Card : _________________________________
Credit card Number _____________________________________________
Security Code / CVVS __________________________
Expiration Date on CC: ______________ Type of Card: Visa Mastercard Discover
Amount to Charge: _________________________________________________
I hereby authorize the LAW OFFICES OF _______________ to charge the above
referenced card the amount of ___________________ for the fees of
__________________________________________________________ on this __________
day of _______________, 20_____. A c opy o f m y card i s attached. I acknowledge that
neither _____________, nor LAW OFFICES OF ___________________ are my attorney.

___________________________________________________________________________
Authorized Signature

Brian S. Popp, 9-12-2011


CBA/CLE Getting Paid: Using Credit Cards at Your Solo or Small Firm

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