Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) REQUEST FOR ELECTRONIC FILING SOFTWARE Please print or type everything on this form. 2 NAME OF FILER REQUESTING SOFTWARE FORM REQUEST 1 ACCOUNT # (Ethics Commission Filers) OFFICE USE ONLY Date Received 3 NAME OF FILER'S COMMITTEE/ CAUCUS (if applicable) MAILING ADDRESS 4 ADDRESS APT / SUITE # Date Hand-delivered or Postmarked CITY STATE ZIP CODE Date Processed 5 TELEPHONE NUMBER AREA CODE PHONE NUMBER EXTENSION Date Imaged ( ) 6 E-MAIL ADDRESS 7 ** FOR WINDOWS ONLY ** The electronic filing software requires Windows XP Service Pack 3, Windows Vista, or Windows 7 Operating System. Please select the electronic filing software CD that you would like: Campaign Finance Lobby Personal Financial Statement The software CD you have requested will be mailed to the address you provided above. 8 Are you required to file campaign finance reports with the Texas Ethics Commission? Yes No www.ethics.state.tx.us Revised 11/03/2011 American LegalNet, Inc. www.FormsWorkFlow.com