_____________________________COURT, _________________________ COUNTY 

aying any amount owed to the Alabama Courts for court costs, fines, etc. while using a credit 

card, charge card or debit card will require an additional 4% credit card processing fee; also 
called administrative or convenience fee. This 4% credit card processing fee will have a 
minimum of $1 if 4% of the amount being paid to the courts calculates to less than $1. 
Anything that calculates to an amount over the $1 minimum will be calculated at 4% exactly. 

           For example, if paying $20 to the Alabama Courts, the 4% convenience fee  
            calculates to $0.80 and will be rounded up to $1. The total collected would  
            be $20 + $1 = $21. Likewise, paying $26 to the Alabama Courts calculates  
            to a $1.04 convenience fee. The total collected would be $26 + $1.04 = $27.04. 

he additional 4% is not an added portion to the judgment or the amount owed; rather it 

covers the processing of the credit card payment pursuant to subpara. (d) (2) of Act 2014-166. 
 

NOTICE: YOU ARE NOT OBLIGATED TO USE A CREDIT CARD, HOWEVER, SHOULD YOU 
DECIDE TO USE A CREDIT, CHARGE OR DEBIT CARD, A 4% ADMINISTRATIVE FEE 
(CONVENIENCE FEE) WILL BE ADDED TO THE AMOUNT OWED TO THE ALABAMA COURTS. 

lso, although you have the right under federal law and the agreement with your Credit Card 
Company or bank to contest a charge, by using a credit card, charge card, or debit card to pay 
what you owe to the Alabama Courts for your judgment, restitution, child support, fines, 
court costs, and/or other fees, you voluntarily waive that right. 

ARNING: YOU COULD FACE FINES, IMPRISONMENT AND OTHER PENALTIES UNDER 
FEDERAL AND STATE LAW SHOULD YOU STEAL, FRAUDULENTLY USE, OBTAIN, OR IN ANY 
WAY MISUSE THE CREDIT CARD OF ANOTHER PERSON. 

           Print Name of Payor: ____________________________________   Date: ______________ 

            Signature of Payor:    ____________________________________ 
            
            Dollar Amount:          _____________ 

 

   

ase Number 

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Attachment A 
NOTICE TO CREDIT CARD PAYORS 

tate Of Alabama 

Unified Judicial System 
Form PS-23 Rev. 04/2018 

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        I, __________________________ , hereby state and attest that I am present at the   
                                             (Payor's Name - Print) 
location above and am paying the debt of __________________________________________  
                                                                                                                                                             (Defendant's Name - Print) 
in the case identified above. I also understand that the Debtor is the party assessed the 

amount owed, not me, and that (s)he pleads guilty to the charge in the case, identified 

above. I also understand that the Debtor cannot transfer, delegate, or in any way force or 

impose this debt upon me. Further, I understand that there are criminal penalties for 

misusing, stealing, or fraudulently obtaining another person's credit card. 

        I do this knowingly and voluntarily and hereby swear or affirm that I will in no way 

contest this payment I make with any entity, including my own credit card company. I hereby 

waive any rights to contest this payment I may have pursuant to any agreement with my 

credit card company or based on federal or state law. I agree the correct payment is stated 

above, and I understand that I am paying the additional 4% which is the administrative 

ase Number 

  C

Attachment B 
AGREEMENT TO PAY DEBT OF 
ANOTHER 

Unified Judicial System 
Form PS-23 Rev. 04/2018 

tate Of Alabama 

  S

   

_____________________________________                                 ____________________ 
Payor (Print)                                                                                              Date 

fee/convenience fee/administrative fee. 

_____________________________________ 
Dollar Amount 

_____________________________________ 
Payor (Signature) 

_____________________________________ 
Payor Address 

_____________________________________ 
Payor City, State, Zip Code 

____________________________________ 
Payor Phone Number 

  _

  _

  _

  _

  _

  _

  _

 

___________________________________                                    ____________________ 
Circuit Clerk’s Office Representative                                                   Date