Payment Request Form
What Court is your Citation with?
Please Select
Millard County Justice Court
Fillmore City Justice Court
Delta City Justice Court
Name:
First Name
Last Name
Email:
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth:
-
Month
-
Day
Year
Date
Citation or Case/Court Docket#:
Citation# example: C178000234, M10600064, 70001 / Case/Court Docket# example: 225000789
How much can you pay each month?
Minimum payment amount is $25
Submit
Should be Empty: