United States District Court Southern District of Texas Houston Division Fax: 713-250-5356 Phone: 713-250-5500
Copy Request Form and Credit Card Authorization Date: Firm: Address:
Requested by: Credit Card: Card Number: Signature of Card Holder: ____ Visa ____ Master Card
Phone: ____ American Express Expires: _____ Discover
Case Number:
Case Name:
Documents Requested ($0.10 per page for electronic documents, $0.50 for paper documents)
Do you require Certified copies? ($9.00 fee per document certified) Search Requested ($26.00 fee for Certificate of Search)
Please send documents via: Fedex Account Number:
Mail ___________ ____________________________
Pick-up ___________