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Get Credit Card Authorization Form - District Of Minnesota

A to charge the following bank card number for payment of filing fees and other court related expenses as designated on this form. Name as it appears on Card: Signature of Cardholder: Date: Name of Law Firm/Business: Credit Card Billing Address: Contact Person Name: Phone Number: CARD INFORMATION Account Number: Exp. Date: Mastercard Visa Discover American Express Diners Reason for Payment Short Case Title: (Required) Transaction (new case, appeal, copies, etc.) D.

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