Credit Card Payment Slip

Secretary of State Credit Card or Prepaid Payment Option/Return/Hold Sheet: If you do not send an acknowledgement copy, you will be charged on your Credit Card, an additional fee of $1.00 for an Acknowledgement copy with your credit card receipt attached. Hold for pickup request will have the receipt attached. Office personnel will not be able to search credit card or prepaid account transactions to help you balance your accounts. Please do not use these options if you have problems collecting receipts from your filing agents. The document of record will be stamped showing the receipt of the filing fee and expedite fee but will not show convenience fees which will be charged by your card service provider (generally these fees are between 2% and 5% of the total charge). Information MUST be typed or filing will be returned without review. PLEASE CHECK WHICH SERVICES YOU ARE REQUESTING Expedite Service for Search Requests Only ($100.00) Charge fees to prepaid account: Account Number and Account Name Typed Name & Signature of Authorized Individual on Account Credit Card Type: Card Number: Card Holder Name: Complete Billing Address: (Visa, MC, Discover & AmEx) Expiration Mo/Yr: / (MM/YY) Street or PO City State Zip Signature of Card Holder: MUST be Signature of Card Holder UCC Credit Card/Prepaid Account Payment Slip ­ 9/2016 American LegalNet, Inc. www.FormsWorkFlow.com