PINELLAS COUNTY
CLERK OF THE CIRCUIT COURT
APPLICATION FOR DEPOSIT ACCOUNT

Account #:________________

Account Name:___________________________________________
Address:___________________________________________
___________________________________________
___________________________________________
___________________________________________
Telephone #:___________________________________________
Fax #:___________________________________________
Contact Person:___________________________________________
Signature:___________________________________________
Account Password: ___________________________________________
(4 to 8 characters)

Mail completed application and check to:

Minimum of $50.00 (fifty dollars) deposit is required to open an account.

Make check's payable to: Clerk of the Circuit Court

The Clerk's Office will automatically charge this account when money sent to record documents, obtain copies or postage for certified or registered mail is short by up to $10.00 of the necessary fee.
I give the Clerk’s Office permission to charge my Deposit Account for amounts greater than ten dollars ($10.00) when insufficient funds are sent to cover transaction fees.
I understand the Clerk’s Office will automatically charge my Deposit Account for amounts ten dollars ($10.00) or less when insufficient funds are sent to cover transaction fees.
I acknowledge that over-payments of ten dollars ($10.00) or less will be automatically deposited into my Deposit Account.
I acknowledge that over-payments of more than ten dollars ($10.00) will be refunded, less a four dollar ($4.00) Clerk's Service Charge as authorized by Florida Statute 28.24.