For Court Use Only. CO-410 C (11/11) May substitute ENTERED stamp. Date received___________________ Login/username_________________ Password_______________________ Initial__________________________ Date login assigned_______________ UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF NORTH CAROLINA Case Management / Electronic Case Filing Filer Registration Form (Limited Filer Access Request) This form shall be used by creditors to register for limited filing privileges to electronically file documents using the Case Management / Electronic Case Filing (CM/ECF) system in the U.S. Bankruptcy Court for the Middle District of North Carolina. The limited filer may only perform specified transactions, as set forth in Paragraph 11 of this form. PLEASE PRINT LEGIBLY Name (First, Middle, Last):______________________________________________________________ Attorney Bar # (if applicable)_________________________________ State:______________________ Firm or Business Name:_________________________________________________________________ Firm or Business Address:_______________________________________________________________ City:______________________________ State:_____________ Zip:_____________________ Telephone Number: __________________________________________Extension__________________ Fax Number: __________________________________________________________________ Email address where electronic notices should be sent:___________________________________________________________________ Email address where you can be contacted regarding this registration request:___________________________________________________________________ I, the limited filer, certify under penalty of perjury that I am authorized by the above-named entity to submit this registration form, and I understand and agree to adhere to the following: 1. I understand that use of my login and password constitutes my signature on an electronically filed document for all purposes, including those under Federal Bankruptcy Rule 9011, Local Bankruptcy Rule 5005-4(8), and 28 U.S.C. § 1746, and shall have the same force and effect as if I had affixed my signature on a paper document being filed. Signatures will be indicated by “s/” and the typed name of the person signing in the following format: “s/ Jane Smith” on the signature line. American LegalNet, Inc. www.FormsWorkFlow.com CO-410 C (11/11) 2. I shall maintain the accuracy of my account (e.g., mailing address, telephone number, fax number, e-mail address), and immediately notify the Bankruptcy Court of any changes in the information on this registration form. 3. I shall protect and secure the login and password issued by the court, and I shall be solely responsible to the court regarding each record entered into the CM/ECF system using my login and password. The login and password will be used only by me and by employees to whom I give authorization. Authorized employees shall review the terms of the limited filer registration form. If there is reason to suspect the password has been compromised in any way, it is my duty to change my password and immediately notify the court. This should include the resignation or reassignment of any persons authorized to use the login and password. 4. I may notify the court to terminate my status as a limited filer at any time. If I cease to be an employee or agent of the entity on whose behalf documents are being electronically filed with the court, or for any reason cease to be authorized to file electronically on behalf of the entity, I will promptly notify the court. 5. I understand that electronically filed documents requiring original signatures from any person other than me, including employees to whom I have given permission to use my password, must be maintained by me in paper form, bearing the original signatures, for four (4) years after closing of the case or proceeding in which the documents were filed. Upon the court's request, I must provide the original signed documents for review. 6. I agree to adhere to and abide by the most recent Local Rules and General Orders of the U.S. Bankruptcy Court for the Middle District of North Carolina, and all technical and procedural requirements set forth therein. 7. I have read and will follow the Administrative Guide to CM/ECF promulgated by the U.S. Bankruptcy Court for the Middle District of North Carolina. 8. I expressly consent to receive notices and service of pleadings and other papers by electronic means from the court and other filing users in all cases in lieu of conventional service of documents as provided in the Local Bankruptcy Rules. 9. I will be responsible for the prompt payment of all filing fees for any document I file using the court's CM/ECF system. 10. I will be required to complete a training assignment on the court's CM/ECF training database. I understand that this training assignment is mandatory, regardless of whether I have received training or currently file electronically in any other court. 11. Limited filing privileges are narrow in scope. I will only use CM/ECF to electronically file the following: Notice of Appearance and Request for Notice, Request for Notice, Transfers of Claims, Reaffirmation Agreements. The court reserves the right to modify these options or add additional options as deemed necessary. 12. I understand that the court's CM/ECF system cannot be used to file Proofs of Claims electronically. I am not submitting this registration form with the intention of using it to file Proofs of Claims electronically with the court. American LegalNet, Inc. www.FormsWorkFlow.com CO-410 C (11/11) 13. I understand that the court's CM/ECF system cannot be used to file Rule 3002.1 Mortgage Payment Documents electronically (i.e., Notice of Mortgage Payment Change; Notice of Postpetition Mortgage Fees, Expenses, and Charges; Response to Notice of Final Cure Payment). I am not submitting this registration form with the intention of using it to file Rule 3002.1 Mortgage Payment Documents electronically. 14. I understand that using my limited filer account to monitor general activity in any case in which I have not filed a document is beyond the scope of my limited filing privileges. The limited filer account is intended for performing the specific transactions in Paragraph 11. In order to view and retrieve electronic docket sheets and documents available on CM/ECF, I will use PACER. [Note: A PACER login and password may be obtained from the PACER Service Center. Registration for a PACER account is available online at http://pacer.psc.uscourts.gov. For assistance, call 1-800-676-6856.] 15. At any time without advance notice, the court may, sua sponte, terminate my account for any reason and require future documents to be filed conventionally or in any other format specified by the court. ______________________________________________ Signature of Applicant Please return this form to: _______________________________ Date U.S. Bankruptcy Court Middle District of North Carolina ATTN: CM/ECF Registrations P.O. Box 26100 Greensboro, NC 27402-6100 Your login and password will be emailed to the email address supplied above as a test of the CM/ECF email notification system.