UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION Request for Copy Services Fees for all orders must be prepaid Make all checks payable to: Clerk, U.S. Bankruptcy Court All payments must be processed through the cashier. Do not make any payments to any other deputy clerk. Date of Request: Case Number: Case Name: Check One: Docket Claims Register Creditor Register Other Do you want the docket cover sheet? Yes No Documents to be copied: Do you want the documents certified? Yes No Ordered by: (Your name) Address: Telephone Number: OFFICE USE ONLY Total Number of Electronic Pages: x .10 = Cost: $ Total Number of Pages to be Copied: x .50 = Cost: $ $0.00 Total Number of Certifications: x $9.00 = Cost: $ $0.00 $0.00 Total Cost: $ $0.00 Deputy Clerk American LegalNet, Inc. www.FormsWorkflow.com