Contra Costa County Bar Association Fee Mediation/Arbitration Credit Card Payment Form
If you choose to pay by credit card, please return this form along with your Mediation/Arbitration Request.  Thank you.

  _________  AMEX      _________  DISCOVER     _________  MASTERCARD      _________  VISA

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Number
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Expiration Date
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Fee Mediation/Arbitration Filing Fee Amount Authorized
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Cardholder Signature
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Cardholder Name
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Address
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Telephone Number
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Date
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Name of the attorney/client with whom you are having the dispute