UNITED STATES DISTRICT COURT EASTERN DISTRICT OF PENNSYLVANIA DOCKET REQUESTS VIA ELECTRONIC ACCESSPLEASE PRINT: Name:___________________________________________________________________ ___ Firm/Company:___________________________________________________________ ___ Address:________________________________________________________________ ___ City:______________________________State:____________Zip Code:__________ ___ Phone No.:______________________________Fax No.:________________________ ___ Case Numbers: (Please indicate case type - Civil, Criminal, Magistrate, Misc., Asbestos) ________________________________________________________________________ ___ ________________________________________________________________________ ___ ________________________________________________________________________ ___ PLEASE CHECK ONE: Mail dockets and the bill for electronic access to the above address. Mail Fax the dockets to the above address and charge the bil l for electronic access to my: Visa MasterCard . Card Number:_____________________________________ Exp. Date:____________ ___ Signature:______________________________________________________________ ___ I will pick up dockets on __________________________________ ____________. I hereby authorize the above-listed dockets to be prepared via electroni c access. I understand the cost will be $0.60 per minute of electronic access time. Signature:_____________________________________________ Date:___________ ___