Form 807 - Card Payment Form
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1SECRETARY OF STATE
CARD PAYMENT FORM
(512) 463-5709
CORPORATIONS SECTION
FAX NO.
FOR CUSTOMER USE (
)
PLEASE PRINT OR TYPE
Name of Cardholder:
Address:
City:
State:
Zip:
Phone No.: (
)
FAX No.: (
)
TYPE DOCUMENT TO BE FILED:
NAME OF ENTITY:
EXPEDITED HANDLING REQUESTED ! ! ! ! YES
! ! ! ! NO
SPECIAL INSTRUCTIONS:
(Additional charge of $25 for document processing)
(Additional charge of $10 for copies/certificates)
SELECT PAYMENT CARD TYPE AND PROVIDE REQUESTED INFORMATION
The undersigned authorizes the fees to be charged to:
The undersigned authorizes the fees to be charged to:
! ! ! ! LegalEase
! ! ! ! VISA ! ! ! ! MASTERCARD ! ! ! ! DISCOVER
(For information about LegalEase, call 1-800/253-5749)
Card No.: _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _
Card No.: 5 0 0 6 7 9 - _ _ _ _ _ - _ _ _ - _ _
Expiration Date: _ _ / _ _ (MO/YR)
Client No.: _ _ _ _ _ _
Case No. _ _ _ _
Signature:
Signature:
FOR SECRETARY OF STATE USE
! ! ! !
PROCESSED BY:
FILED
NEWT ! ! ! ! CHAT ! ! ! ! STAT ! ! ! ! CERT ! ! ! ! OTHER ! ! ! !
REJECTED ! ! ! !
EXAMINER NAME
File Number
,
,
$
FILING FEE(S):
EXPEDITED HANDLING FEE:
$
CID #
S.0. #
CERTIFYING FEE:
$
FILING GUIDE:
$
(Credit Card Only)
Processing Charge 2.1%
$
TOTAL AMOUNT
$
Form No. 807
(Rev. 9/99)
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