FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, and Address): SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE DIRECT FAX FILING REGISTRATION FORM Registrant’s Information: Name: State Bar Number # (Attorney Only) Address: City: State: Phone Number: ( Zip: ) Fax Number: ( ) Email Address: I, _______________________________________, am registering as a Fax Filing User with the Superior Court of California, County of Riverside. I agree to pay a $125.00 registration fee that will allow me to fax file documents to the Court during the period of July 1st through June 30th. I understand that a new registration fee will be due each fiscal year. When sending my fax filings, I agree to use the Facsimile Transmission Cover Sheet (RI-MC005) as my cover page. If I am an attorney, I agree to provide my State Bar Number on each Fax Filing sent to the Court. I consent to receive my conformed copy of filed documents by electronic mail, and I agree to provide my email address on each Fax Filing sent to the Court. I understand that failure to provide my email address on a document waives my request for a conformed filed copy of that document. If I am an attorney, I understand that my registration applies to me as an individual attorney, and not a group of attorneys (law firm). I declare that the foregoing is true and correct and that I am agreeing to the requirements for registering as a Fax Filing User. __________________________________ ________________________________ (PRINT NAME) (SIGNATURE) Registration Fee - Credit Card Payment I authorize the fax filing registration fee amount of $125.00 to be charged to the following account:  VISA Account No.:  MASTERCARD Expiration date:  DISCOVER CVV2:  AMERICAN EXPRESS _______________________________ (PRINT NAME OF CARDHOLDER) Please create a Login & Password. The login and password needs to be at least 6 characters (numbers or letters or a combination of both). LOGIN __________________________ PASSWORD ______________________ ________________________________ (SIGNATURE OF CARDHOLDER) RI-MC001 Rev. 05/15/12 American LegalNet, Inc. www.FormsWorkFlow.com