UNITED STATES BANKRUPTCY COURT DISTRICT OF VERMONT ELECTRONIC CASE FILING (ECF) SYSTEM LIMITED PARTICIPANT REGISTRATION FORM Live System This form is to be used to register for LIMITED FILING PRIVILEGES for filing documents via the Court's Electronic Case Filing system (ECF). Limited filing privileges shall include the authorization to file the following with the Clerk's office via the Internet: � proof of claim � withdrawal of claim � reaffirmation agreement � creditor's request for notice Additional privileges may be added at the discretion of the Clerk. The undersigned certifies under penalty of perjury that he/she is properly authorized to submit this ECF Registration form on behalf of the agency/company identified below. By submitting this registration form, the agency/company agrees to adhere to the terms and conditions specified on this form. Name (First, Middle, Last): Agency/Company: Mailing Address: Voice Phone Number: E-Mail Address: Extension: By signing and submitting this registration form, I agree to abide by the following requirements: 1. Signatures on proofs of claim, notices of appearance and/or requests for service/notice, notices of transfer of claims, etc., shall be indicated by " /s/" and the typed name of the person signing in the following format (e.g. "/s/ Jane Smith") on the signature line. My password constitutes my signature. The login and password for filing via the Internet shall be used exclusively by me and by any of my employees to whom I give authorization. I will not knowingly permit my login and password to be used by anyone other than my authorized employees. Page 1 of 3 Version September 18, 2013 American LegalNet, Inc. www.FormsWorkFlow.com 2. UNITED STATES BANKRUPTCY COURT DISTRICT OF VERMONT 3. 4. 5. I will select and activate a new password in ECF if an employee of mine who has been authorized to use my login and password no longer serves in such a capacity. I will report any suspected compromise of my password to the Court's systems staff at (802) I will abide by all of the requirements set forth in the United States Bankruptcy Court, District of Vermont Local Bankruptcy Rules (Vt. LBR) currently in effect, and any changes or additions that later may be made. I have the option to accept service and notice electronically (via e-mail) from the Court. Doing so waives my right to service and notice by personal service, mail, or other methods as authorized by the Federal Rules of Bankruptcy Procedure, Federal Rules of Civil Procedure, and this court's local rules for all documents filed and entered on the docket in any case whether submitted by a party or issued by the Court. Entering an e-mail address in your ECF USER PROFILE after being assigned a User ID and password constitutes your election to receive electronic notice and waives your right to conventional notice. 6. I understand that if I enter an e-mail address in my ECF USER PROFILE, that on behalf of myself and my clients, I am voluntarily and knowingly: a) NOT waiving any right to service in regard to service of a summons and complaint as required by Fed. R. Bankr. P. 7004; b) electing to receive notice electronically (via e-mail) from the Court of all documents filed and entered on the docket, whether submitted by a party or issued by the Court; c) agreeing that the ECF system's automatic transmission of the "Notice of Electronic Filing" shall be considered equivalent to service of the pleading or other paper by first class mail, postage prepaid; d) waiving the right to service and notice by personal service, mail, or other methods as authorized by the Federal Rules of Bankruptcy Procedure, Federal Rules of Civil Procedure, and this court's local rules for all documents filed and entered on the docket in any case whether submitted by a party or issued by the Court and consent instead to receive notice electronically, except for the receipt of service for summons per item a) above; and e) waiving the right to receive notice of entry of orders and judgment under Fed. R. Bankr. P. 9022 and consent instead to receive notice electronically. Page 2 of 3 Version September 18, 2013 American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES BANKRUPTCY COURT DISTRICT OF VERMONT I further acknowledge that I have read and understand the United States Bankruptcy Court District of Vermont Local Rules as they pertain to electronic filing. Applicant Signature: ________________________________________ Applicant Name (Please Print): Date: Last 4 Digits of Applicant's Social Security Number (for security purposes): xxx-xx- Mail or deliver this completed form to us at: U.S. Bankruptcy Court, District of Vermont _____________________________________ Deputy Clerk Of U.S. Bankruptcy Court - VT (to be signed upon receipt of application) Date: ________________ Page 3 of 3 Version September 18, 2013 American LegalNet, Inc. www.FormsWorkFlow.com