UNITED STATES BANKRUPTCY COURT

MIDDLE DISTRICT OF GEORGIA

ELECTRONIC FILING SYSTEM

Limited Filer Registration Form

To register for an account under the Court's Electronic Filing System to file proofs of claim, please provide the information requested below. A limited filer may file proofs of claim and other claim related actions, requests for notice, reaffirmation agreements and certain other documents.

"Firm" is the name of the entity on whose behalf the Filer is authorized to file electronically.

First / Middle / Last Name:  (NOTE: This field is required.)
Firm Name:

        Firm Address:

Street Address  (NOTE: This field is required.)
Address (cont.)
City  (NOTE: This field is required.)
State/Province  (NOTE: This field is required.)
Zip/Postal Code  (NOTE: This field is required.)
Country
Firm Tax ID Number:
Your Direct Telephone Contact Number:
Filer's Fax Number:
Email Address for Login/Password Correspondence:  (NOTE: This field is required.)
Email Address for CM/ECF Electronic Notification:

        By choosing "Yes" below and submitting this form, the filer agrees as follows:

1. Rule 9011 of the Federal Rules of Bankruptcy Procedure requires that every proof of claim be signed by the person authorized to submit the proof of claim for filing ("Responsible Person"). The filer will check to be sure the image of the signature of the responsible person is attached to or part of each proof of claim filed electronically. The unique password issued to the filer registered to use the Electronic Case Filing System identifies the filer to the court each time that the filer logs on to the Electronic Case Filing System. The use of a filer's password serves as and constitutes the signature of the filer for purposes of indicating an understanding of and an agreement to comply with the orders and procedural directions of the court concerning the electronic filing of proofs of claim. Therefore, a filer must protect and secure the password issued by the court. If any reason exists to suspect the password has been compromised in any way, it is the duty and responsibility of the filer to notify the court immediately and the court will thereafter immediately delete the password from the Electronic Filing System and issue a new password if appropriate.

2. If the filer ceases to be an employee or agent of the creditor on whose behalf the filer was authorized to file claims or ceases for any reason to be authorized to file proofs of claim electronically for that creditor, the filer will immediately inform the Clerk of Court in writing that the filer is no longer an authorized filer and will cease using the login and password issued to that filer. If any of the information on the registration form changes, for example the user's mailing address, e:mail address, or other relevant information, the user must update that information in CM/ECF through his/her user account.

3. The filer  has read the local rules of this court including Local Bankruptcy Rule 5005-4 and the Administrative Procedures for Filing, Signing, and Verifying Pleadings and Papers by Electronic Means.

Yes No

To prove you're a human, please enter MYGAMB in this field:  (NOTE: This field is required.)