|NEVADA QUICK DIVORCE
THIRD PARTY CREDIT CARD AUTHORIZATION FORM
I, ____________________________________________________________________, authorize Nevada Quick Divorce to charge $__________________to the credit card designated below for typing services and/or court costs for ________________________________________________________ (client's name). I understand that Nevada Quick Divorce will process the charge immediately and that any cancellation of services at a later date will not be entitled to a refund of services, only pre-paid court costs that have not been expended. Once the papers have been typed Nevada Quick Divorce's fees have been fully earned and no refund will be given.
I waive receipt of the papers and authorize delivery of said papers to:
By submitting this form I acknowledge that I have read, understand and agree to all disclosures and terms as contained in this document.
_____ I Agree _____ I Disagree (check one).
By submitting this form to Nevada Quick Divorce I am authorizing the charge to my
credit card for this purchase, the same as if I had personally signed a credit card purchase/payment
receipt and I will be responsible for all collection fees and any other fees associated with the collection
of my payment, should it become necessary.
Date of Authorization: __________________________ Telephone
Date of Authorization: __________________________ Telephone Number: ____________________________Signature of Card Holder: ___________________________
Please fax to (775) 787-8272