UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF GEORGIA ELECTRONIC PROOFS OF CLAIM CREDITOR REGISTRATION FORM Entities filing proofs of claim and/or transfers of claims in cases pending in the U.S. Bankruptcy Court for the Northern District of Georgia (“Creditors”) that desire to be authorized to file such documents electronically should complete this registration form and submit it to the Clerk. “Firm” is the name of the Creditor entity on whose behalf an employee or agent (“Filer”) is to be issued a login and password and authorized to file electronically proofs of claim and/or transfers of claims. Complete a separate form for each separate corporate or other distinct legal entity. Firm Name: Firm Address: Contact Person: Voice Phone Number: FAX Phone Number: Internet E-Mail Address: By submitting this registration form, the undersigned Creditor agrees as follows: 1) Rule 9011 of the Federal Rules of Bankruptcy Procedure and Official Form 10 require that every proof of claim be signed by the person authorized to submit the proof of claim for filing (“Responsible Person”). Creditor will direct each of its Filers and each of its Responsible Persons to read and to comply with the orders and procedural directions of the Court concerning the electronic filings of proofs of claim. 2) If a Filer ceases to be an employee or agent of the Creditor or for any other reason ceases to be authorized to file proofs of claim electronically on behalf of the Creditor, the Creditor will promptly notify the Clerk. American LegalNet, Inc. www.FormsWorkFlow.com 3) The undersigned has read BLR 5005-9. The undersigned certifies under penalty of perjury that he or she is properly authorized to submit this Creditor Registration Form on behalf of the above identified Firm. Date: _________________________ ____________________________________ Signature ____________________________________ Office or Position with the Creditor Firm Address and telephone (if different from information provided above) ____________________________________ ____________________________________ ____________________________________ If you are already a registered CM/ECF Bankruptcy filer in another court, you will not have to go through a “Testing” phase to obtain a “Live” login and password to our database. To omit the “Testing” phase of our registration, please list the U.S. Bankruptcy court(s) below for which you are currently registered: _________________________________ ____________________________________ _________________________________ ____________________________________ _________________________________ ____________________________________ ____________________________________ Signature Please return to: Clerk of Court United States Bankruptcy Court 1340 U.S. Courthouse 75 Spring Street, S.W. Atlanta, GA 30303 American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF GEORGIA ELECTRONIC PROOFS OF CLAIM FILER REGISTRATION FORM (Live System) To register for an account on the Court’s Electronic Filing System, please provide the information requested below. “Firm” is the name of the entity on whose behalf the Filer is to be authorized to file proofs of claim and transfers of claims. If Filer is employed by more than one entity in the same group of entities, attach a continuation sheet with the information requested for each such entity. First/Middle/Last Name: Firm Name: Firm Address: Filer’s Voice Number: Filer’s FAX Number: Filer’s E-Mail Address: By submitting this registration form, the undersigned Filer agrees as follows: 1) Rule 9011 of the Federal Rules of Bankruptcy Procedure and Official Form 10 require that every proof of claim be signed by the person authorized to submit the proof of claim for filing (“Responsible Person”). Filer will check to be sure an image of the signature of the Responsible Person is attached to or part of each proof of claim filed electronically. The unique password issued to a Filer registered to use the CM/ECF system identifies that Filer to the Court each time that the Filer logs on to the CM/ECF system. The use of a Filer’s password serves as and constitutes the signature of the Filer for purposes of indicating an understanding of and agreement to comply with the orders and procedural directions of the Court concerning the electronic filing of proofs of claim. Therefore, a Filer must protect and secure the password issued by the Court. If any reason exists to suspect the password has been compromised in any way, it is the duty and responsibility of the Filer to notify the Court immediately. The Court will thereafter immediately delete that password from the electronic filing system and issue a new password. 2) If the Filer ceases to be an employee of the Creditor on whose behalf the Filer was authorized to file claims or ceases for any reason to be authorized to file proofs of claim electronically for said Creditor(s), the Filer will immediately inform the Clerk of the Court in writing that the Filer is no longer an authorized Filer and will cease using the logon and password issued to that Filer. If any of the information provided by Filer on this form changes, Filer will American LegalNet, Inc. www.FormsWorkFlow.com promptly send an amended registration form to the Clerk with the then current information. 3) The undersigned has read BLR 5005-9. Date: ____________________________ ____________________________________ Applicant’s Signature Approved: ____________________________________ Signature of Authorized Supervisor of Applicant ____________________________________ Office or Position with the Creditor Firm Address and telephone (if different from information provided above) ____________________________________ ____________________________________ ____________________________________ If you are already a registered CM/ECF Bankruptcy filer in another court, you will not have to go through a “Testing” phase to obtain a “Live” login and password to our database. To omit the “Testing” phase of our registration, please list the U.S. Bankruptcy court(s) below for which you are currently registered: __________________________________ ____________________________________ __________________________________ ____________________________________ ____________________________________ Signature Please return to: Clerk of Court United States Bankruptcy Court 1340 U.S. Courthouse 75 Spring Street, S.W. Atlanta, GA 30303 American LegalNet, Inc. www.FormsWorkFlow.com