Court-Ordered Funds Release Request Form

Court-Ordered Funds Release Request Form
Request the release of funds subject to a court order by providing case details, release information, supporting order details, and a final authorization.
Requestor and Case Details
Full Name
First NameMiddle NameLast Name
Role in Case
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Court Case Number / File Reference
Jurisdiction / Court Name
Funds Release Information
Amount Requested for Release
Currency
Source of Funds / Holding Account Description
Reason for Release
Date Funds Are Needed
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Supporting Order and Delivery Details
Court Order Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of Order Authorizing Release
Are supporting documents attached?
Preferred Delivery Method
Special Instructions
Authorization and Certification
Requester Signature
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