Aswift Credit Card Authorization Form

A Swift Script

201 S. Research Place, #102, Central Islip, New York 11722  (888) 866‐5134, Fax: (800) 860‐5722, [email protected]  CREDIT CARD AUTHORIZATION FORM Please circle transcript turnaround time desired. [Expedited Service: Same day: $5.00 pp, Overnight: $4.25, 3-days: $3.75] [Regular Service: One week: $3.25 pp, 14-days: $2.75 pp, 30 days: $2.25 pp]

Ordering Person’s Name: Ordering Person’s Signature: Ordering Person’s Phone number: Credit Card Number: Credit Card Expiration Date: Credit Card 3 or 4 digit security code (4 digits if Amex/front of card): Credit card billing address (zip code required):

Name and Signature of Credit Card Owner if different from Ordering Person:

Firm Name (if applicable): CASE NAME: CASE NUMBER: HEARING DATE: COURT: Due to the increased number of chargebacks in this economic climate, this form has become necessary in processing transcript requests when payment is by credit card. Thank you for your cooperation. Please email to [email protected]  or fax to (800) 860-5722