Customer Order Form For Copies

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CUSTOMER ORDER FORM FOR COPIES
$1.00 Per Page For All Copies
NO PERSONAL CHECKS ACCEPTED
ATM available at 1201 Franklin, 1st Floor
TO BE COMPLETED BY THE CUSTOMER (PLEASE PRINT)
CUSTOMER #____________
CAUSE NUMBER: ______________________________________
STYLE: ________________________________________________ VS. ______________________________________________
NEED COPY OF: PLEASE CHECK
PETITION
DATE OF FILING: ____________________________
NUMBER OF COPIES: _______
DECREE/JUDGMENT
DATE OF DECREE/JUDGMENT: ______________
NUMBER OF COPIES: _______
ORDER
DATE OF ORDER: ___________________________
NUMBER OF COPIES: _______
OTHER, PLEASE SPECIFY:
____________________________________________________________________________
NUMBER OF COPIES: _______
____________________________________________________________________________
NUMBER OF COPIES: _______
____________________________________________________________________________
NUMBER OF COPIES: _______
____________________________________________________________________________
NUMBER OF COPIES: _______
PLEASE SPECIFY:
( ) CERTIFIED
or
( ) UNCERTIFIED
CUSTOMER'S NAME (Please Print): ___________________________________________________________________________
ATTORNEY'S BAR NO. _______________________ LAW FIRM'S I.D. NO: _________________________________________
PHONE NUMBER: __________________________________________________________________________________________
ADDRESS: __________________________________________________________________________________________________
Indicate Form of Payment:
CASH: ________________________________________
Amount Given To Clerk
If tendering cash, indicate Payor’s Name you wish to be reflected on receipt: _______________________________________
CREDIT CARD: ____________________
Name on Credit Card: __________________________________
Credit Card Type
MONEY ORDER/CASHIER’S CHECK Type: ______________
Number: ____________________________
MAIL REQUESTS CAN BE PLACED AT ANY WINDOW. WILL-CALL REQUESTS (CALL WHEN READY) MAY BE PLACED AT WINDOW #9.
FOR DISTRICT CLERK'S OFFICE USE ONLY
Court: _______________________________________________________
Total Number Of Pages/Screens: _____________________________________
Order Taken By: _______________________________________________
Date: __________________________________________________________
Number Of Screens Printed/Verified By: _____________________________________________________________________________________________________
Transaction Number: ___________________________________________
Receipt Number: _________________________________________________
Number Of Copies/Print-Outs: ____________________________________
Number Of Pages/Screens Per Copy Print-Out: __________________________
Volume/Page: ________________________
Frame/Roll: _____________________
Imaged Number: _____________________________________________
SPECIAL INSTRUCTIONS: ______________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
Large Order, Customer to Return: ________________ Date:
_____________________ Time: ____________________________
Revised 8/21/07

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