Ohio R. Prac. S. Ct. app G
SUPREME COURT OF OHIO
CREDIT CARD FILING FEE FORM
This form provides the Clerk's Offi ce with the necessary information to process a new appeal or new original action and charge the one-hundred ($100) dollar filing fee, and one-hundred ($100) dollar security deposit, if applicable, to the credit card you have provided. Please note that you are responsible for providing correct information that is clear and legible. Incorrect or illegible information, or rejected credit cards, may result in the Clerk's Office rejecting your notice of appeal thus divesting the Supreme Court of jurisdiction or rejection of your original action. You may wish to contact the Clerk's Offi ce to confi rm that we were able to fi le your original action or timely fi le in your appeal. The phone number is (614) 387-9530.
NAME AS IT APPEARS ON CREDIT CARD ________________________________________
ADDRESS _____________________________________ ZIP CODE _______________
CITY __________________________________ STATE ________
EMAIL ADDRESS _____________________________________________________________
CASE CAPTION _______________________________________________________________
_____________________________________________________________________________
(Please use the caption and prior case number as provided on the entry that you are appealing)
CREDIT CARD NUMBER _________________________________________________
ExPIRATION DATE ______________ CORPORATE CARD ____YES _____ NO
CARD TYPE MasterCard _______ Visa _______ American Express _______
TELEPHONE NUMBER ___________________________________________________
Please provide a number at which you can be reached from 8 a.m. to 5 p.m. Monday through Friday. The number will be used if the information you provided is incorrect or illegible. If we are unable to reach you and the charge is not accepted for any reason the appeal or original action will not be fled thus possibly divesting the Supreme Court of jurisdiction to consider your case.
| ________ $100 Filing Fee | OR | _______ $100 Filing Fee and $100 Security Deposit |
By initialing the appropriate line above and signing and dating below you authorize the Clerk's Offce to deduct the specifed amount required to initiate an appeal or original action with the Ohio Supreme Court from the credit card provided above.
SIGNATURE _________________________________________ DATE ______________
PLEASE NOTE THAT IT IS THE CLERK'S OFFICE POLICY TO DESTROY THIS FORM IMMEDIATELY UPON THE FILING OF THE CASE
Ohio. R. Prac. S. Ct. app G