Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 REQUEST FOR ELECTRONIC FILING PASSWORD FORM 1 Please print or type everything other than your signature. See back for additional informatlon about completing this document. 2 NAME OF FILER REQUESTING PASSWORD (see instructions) 3 MAILING ADDRESS PASS FILER ACCOUNT # OFFICE USE ONLY Date Received NAME OF FILER'S COMMITTEE/ CAUCUS (if applicable) 4 1-800-325-8506 ADDRESS APT / SUITE #; Date Hand-delivered or Postmarked CITY; STATE; ZIP CODE PASSWORD: 5 TELEPHONE NUMBER 6 ) FILER SECRET QUESTION 9 EXTENSION OFFICE SOUGHT (if known) 8 ( PHONE NUMBER OFFICE HELD (if any) 7 AREA CODE ANSWER TO FILER QUESTION 10 FILER SIGNATURE I swear that I am the person required by Title 15, Election Code, to file campaign finance reports with the Texas Ethics Commission. This document is my official password request for the purpose of filing electronic campaign finance reports with the Texas Ethics Commission. Signature of Filer 11 IF APPLICABLE, CHECK HERE I authorize the Texas Ethics Commission to release my password to: ______________________________________ ________________________ Name Phone # Revised 01/14/2009 American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506 REQUEST FOR ELECTRONIC FILING PASSWORD Passwords are used to enable you to file Texas Ethics Commission campaign finance reports electronically regardless of what method of transfer you have selected. The Ethics Commission electronic filing software uses your unique password and the Ethics Commission filer account number to digitally encrypt and sign your electronic campaign finance reports. To receive a password, the person responsible for filing reports must complete this form and return it by mail to the Texas Ethics Commission, P.O. Box 12070, Austin, TX 78711-2070, by fax to 512-463-8808, or by hand-delivery to 201 E. 14th St., Sam Houston Bldg., 10th Floor, Austin. It is your responsibility to protect your password. If you forget your password, contact the Ethics Commission at one of the numbers listed above. You will be given your password ONLY after you correctly answer the question you provided in Box 8. INSTRUCTIONS FOR COMPLETING THIS FORM The following numbers correspond to the numbered boxes on the other side. 1. Filer Account #. Enter the filer account number assigned by the Texas Ethics Commission. If you are a candidate/ officeholder, enter the number assigned to you. If you are the campaign treasurer of a political committee, enter the number assigned to the political committee. If you are the chair of a legislative caucus, enter the number assigned to the caucus. Please note that the filer account number is NOT the same as the official password to file electronically. 2. Name of Filer Requesting Password. Person who requests password must be the candidate/officeholder, or the campaign treasurer of a political committee, or a caucus chair. 3. Name of Filer's Committee/Caucus. If you are a candidate/officeholder, SKIP this section. If you are a campaign treasurer of a political committee, enter the name of the political committee for which you are requesting a password. (You must submit one Form PASS for each committee filing electronic reports for which you are a treasurer.) If you are a caucus chair, enter the name of the caucus. 4. Mailing Address. Enter the complete address of the filer requesting the password. The Ethics Commission will mail the official password to the address provided. 5. Telephone Number. Enter the telephone number of the filer requesting the password, including the area code and, if applicable, the extension number. 6. Office Held. If you are an officeholder, enter the office you currently hold. 7. Office Sought. If you are a candidate, enter the office you seek, if known. 8. Filer Secret Question. Enter a question. Chose a question to which only you know the answer. If you forget your password, this is the question you will be required to correctly answer before the Ethics Commission gives you your password. 9. Answer to Filer Question. Enter the answer to the question you entered in Box #8. For your security and convenience, make sure the answer is something that only you know and that is extremely difficult for others to guess, even if they are asked your question. If you forget your password, this is the answer you will be required to give to the question in Box #8 before the Ethics Commission gives you your password. 10. Filer Signature. Sign after reading the statement. 11. If Applicable, Check Here. If you will not be available to obtain your password from the Ethics Commission, you may authorize the release of your password to the person you name. (The password will be released to the person you name when the secret question you provided in Box 8 is answered.) Revised 01/14/2009 American LegalNet, Inc. www.FormsWorkflow.com