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Professional Process Servers
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Request for Service

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Company name:
First name:
Last Name:
Address:
City:
State:
Zip:
Telephone:
Email:
Type of Writ:
Date of Hearing/Dep:
Time of hearing/Dep:
Service Address:
City:
State:
Zip:
Service phone 1:
Service phone 2:
May we contact by telephone?:
Late day to Serve:
Subject Description:
Special Instructions:
I am authorized to enter into contract on behalf of the company listed above and to request and authorize payment of such services.  I acknowledge that payment must be made net 15.  By entering my name below, in addition to described terms, I accept that if not found to be legally entitled to enter into binding agreement on behalf of aforementioned Company in a court of law, I am liable for all charges described by this submission.  I also understand that I have the option of pre-paying for services by sending payment to:
Florida Process Servers
4121Chardonnay dr.
Rockledge, FL 32955
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Select you option to agree or disagree.

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