OFFICE OF TENESHIA HUDSPETH
COUNTY CLERK, HARRIS COUNTY, TEXAS
COUNTY CIVIL COURTS DEPARTMENT
P.O. Box 1525 Houston, TX 77251-1525 Phone: 713-755-6421Fax: 713-755-4710
www.cclerk.hctx.net CCOCivilFM@cco.hctx.net
Form No. H-01-87 (Rev. 11/17/2019)
FOR CUSTOMER USE ONLY (Please print or type)
Name of Cardholder: Date:
PLEASE PROVIDE REQUESTED PAYMENT INFORMATION
Credit Card: □ Visa □ MasterCard □ Discover □ American Exp.
There is a 4% surcharge on all services requested by mail, email, phone or fax.
Card No. ___________________________________ Expiration Date: ___________
Card Code __________ Cardholder’s Signature:
□ Frost Bank LegalEase Card No.500679-_____________________________
Client No.: __ __ __ __ __ __ Account Signature:
PLEASE PROVIDE TYPE OF SERVICE REQUESTED
□ Certified Copy of document on file (certified copies cannot be faxed or Emailed to customer)
□ Non-Certified Copy of document of file
Copies delivered by: □ Mail to address above □ Fax to number above
□ Customer will pick up □ Email to address above
* Some document(s) may exceed the outgoing email file size limitations
□ Payment of filing fees – original documents only, no fax filings will be accepted.
PROVIDE COPY OR FILING INFORMATION & INSTRUCTIONS
List PLEASE PROVIDE TYPE OF
For County Clerk Use Only:
Approval Code:__ __ __ __ __ __
Requested by: □ fax □ phone □ mail □ email
