IN THE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA Please list the Case Name and Case Number of the Case(s) in which you are Requesting Electronic Filing Privileges: Case Name Case Number P RO SE E - FILING AGREEMENT AND / OR REQUEST FOR ELECTRONIC NOTICES PRO SE E - FILING REGISTRATION : I understand that I am required to complete my own application for CM/ECF registration. I am a pro se party in the above - captioned case(s). A username and password to the court s electronic filing system acceptance of this Agreement a s to one or all of the above - captioned cases. The username and password assigned to me are only for use in the Bankruptcy Court for the Northern District of West Virginia and may only be used in the specifically authorized case(s). Use of the login and password issued by the Court constitute my signature on all electronically filed documents for all purposes, including those und er Rule 9011 of the Federal Rules of Bankruptcy Procedure and 28 U.S.C. 1746. Use of my log - in and password has the same force and effect as affixing my wet signature on a paper document filed with the Court. Every document I file electronically shall be s igned by me, in the following format: "/s/ John Doe", on the signature line. I am solely responsible for any documents submitted electronically to CM/ECF by means of my e - filing login and password. I will protect and secure the password issued to me. If there is reason to suspect that my password has been compromised, it is my responsibility to change my password and immediately notify the Bankruptcy Clerk by calling 304 - 233 - 1655. My e - filing ability may be restricted or revoked by the Bankruptcy Cler k at any time, without notice, and shall terminate on closure of the above captioned case(s). By signing below, I accept these terms and conditions. E - MAIL REGISTRATION , NOTICES OF ELECTRONIC FILING , AND NOTICE REGARDING ELECTRONIC SERVICE OF CERTAIN DOCUMENTS BY OTHER PARTIES IN THE CASE Pursuant to Fed. R. Bankr. P. 9036, whenever the clerk or some other person as directed by the court is required to send notice by mail, I hereby request that all or part of the information required to be contained in the notice be sent via email instead of U.S. mail. Email r egistr ation will result in notification to me of all public documents filed in the above captioned case(s), whether or not the document affects my individual rights. American LegalNet, Inc. www.FormsWorkFlow.com - mail bounce back (u ndeliverable e - mail), my e - mail registration for notices of electronic filing may be terminated without notice, and if terminated, I will receive court notices and orders by U.S. mail and I will no longer be subject to elect ronic service of documents by other parties in the case. If I do not check this box, I will only receive court notices and orders th at affect me by U.S. Mail and will only see public l y filed documents that are specifically served upon me by other parties. Under Fed. R. Civ. P. 5, as it applies to bankruptcy adversary proceedings and contested matters, and under any applicable Local Rule of the Bankruptcy Court, I understa nd that other parties may serve certain document upon me electronically due to the registra tion of my email address with the bankruptcy court s electronic filing system. e P.O. Box 70 Wheeling WV 26003 - filing log - in and password. Signature: Date: Printed Name Address Ln. 1 Address Ln. 2 Address Ln.3 Daytime Phone Number: Email Address: American LegalNet, Inc. www.FormsWorkFlow.com