This form is for Debtor's
Attorneys only. If you are not a Debtor's Attorney, please visit the
National Data
Center at www.13datacenter.com
You must print out and complete this form then mail
or fax to the address or number below before
you will be given access to this site. This information will not be shared
with any other parties.
By submitting this application you declare that you have read and agree with the terms set
forth in the
Web Access Agreement.
Kathy A. Dockery, Chapter 13 Trustee
Attn: Request for User ID
700 S. Flower Street
Suite 1950
Los Angeles, CA 90017
FAX: (213) 996-4426
| YOUR NAME: | _______________________________________ |
| BUSINESS NAME: | _______________________________________ |
| PROPOSED USER NAME: (max 8 characters) | _______________________________________ |
| PROPOSED PASSWORD: (max 8 characters) | _______________________________________ |
| DEBTOR'S NAME and CASE NUMBER(s) for which you are ATTORNEY on RECORD: | _______________________________________ |
| (if you do not have enough
space, please use a separate sheet of paper) |
_______________________________________ |
_______________________________________ |
|
_______________________________________ |
|
_______________________________________ |
|
_______________________________________ |
|
| ADDRESS: | _______________________________________ |
| CITY, STATE: | _______________________________________ |
| ZIP: | _______________________________________ |
| PHONE NUMBER: | _______________________________________ |
| FAX NUMBER (optional): | _______________________________________ |
| E-MAIL ADDRESS: | _______________________________________ |
| SIGNATURE: | _______________________________________ |