CREDIT CARD AUTHORIZATION FORM

I, ________________________________, authorize Nevada Divorce and Document Services, Inc. to charge $_________ to the credit card designated below for typing services and/or court costs for _________________________ (client's name). I understand that Nevada Divorce & Document Services, Inc. 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 Divorce's fees have been fully earned and no refund will be given.

I further declare that the signature appearing below is identical with the signature on this credit card.

Name on Card __________________________________ Credit Card Number ____________________________
Billing Address ____________________________________ Zip Code ________________
Exp. Date ____________ CVC # ____________

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 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 Number: _________________________

Signature of Card Holder: ___________________________________________________________________

Please fax to (775) 996-2817 or email to info@nevadadivorce.net

COSTS: