FORM C UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF NEBRASKA APPLICATION FOR LIMITED USE/CLAIM PASSWORD FOR ELECTRONIC CASE FILING SYSTEM NAME: COMPANY: _______________________________________________________________ LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: _______________________ ADDRESS: CITY/STATE: ______________________________________________________________ PHONE #: FAX #: E-MAIL ADDRESS: BAR ID # (if applicable): STATE OF 1. Pro Hac Vice Application: I affirm that I am admitted to practice in the United States Courts for the ____________ District of ____________ (applicable state) and that the information set forth above is true and correct. 2. I understand that use of my Limited Use password to file a document in the record of a bankruptcy case or proceeding will constitute my signature upon and my signing of any declarations, verifications, proofs of claim, notices of appearance, assignments of claims, reaffirmation agreements, or other papers or documents filed by use of the password obtained pursuant to this Application (my password), for all purposes authorized and required by law, including, without limitation, the United States Code, Federal Rules of Civil Procedure, Federal Rules of Bankruptcy Procedure, Federal rules of Criminal Procedure and any applicable non bankruptcy law. 3. I understand that it is my responsibility to maintain in my records all documents bearing my original signature that are filed using my password, and all documents bearing the original signature of any signer on whose behalf I file the documents using my password, for a period of four (4) years after the case or proceeding in which the papers are files has been closed. 4. I understand that it is my responsibility to protect and secure the confidentiality of my password. If I believe that my password has been compromised, it is my responsibility to notify the Court in writing, immediately. For Court Use Only: Login: _______________________ Password: _________________________ American LegalNet, Inc. www.FormsWorkflow.com Date: ________________________ Initials: ___________________________ 5. I understand that it is my responsibility to notify the Court, immediately, of any change in my address, telephone number, fax number, or e-mail address. 6. Registration as a Filing User constitutes: (1) waiver of the right to receive notice by first class mail and consent to receive notice electronically; (2) waiver of the right to service by personal service or first class mail and consent to electronic service, except with regard to service of a summons and complaint. Waiver of service and notice by first class mail applies to notice of the entry of an order or judgment. Service by electronic means is complete as set forth in the General Order notwithstanding Federal Rule of Bankruptcy Procedure 9036. 7. By this registration, the undersigned agrees to abide by all the rules and regulations in the most recent General Order, Administrative Procedures for Filing, Signing, and Verifying Pleadings and Papers by Electronic Means currently in effect, and any changes or additions that may be made to such Administrative Procedures in the future. Please return to: Applicant Signature U.S. Bankruptcy Court District of Nebraska Attn.: Director, Information Technology Services 111 South 18th Plaza, Suite 1125 Omaha, NE 68102 Date American LegalNet, Inc. www.FormsWorkflow.com