AUTHORIZATION FORM/CREDIT CARD

I, _____________________________, authorize Nevada Quick Divorce to charge $_____________ to my credit card for typing services and/or court costs for __________________________ (name of party). I further agree that the charge may be processed immediately and servicve cancellation is not entitled to any refund. After papers have been typed the fees have been fully earned and no refund will be given.

I further authorize producing the papers to:
Name: ___________________________ Address: ________________________________________________

City _____________________ State: _____________

The signature below is my signature on my credit card.
Name on Card ______________________________________________________

Billing Address _________________________________Zip Code _____________

I am authorizing this charge to my credit card for this purchase, as if I had personally signed a credit card 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: __________________________ Telephone : ____________________________

Signature of Card Holder: ___________________________

Please fax to (775) 787-8272

COSTS: