Free Application to the Administrative Office of the United States Courts for Approval as a Notice Provider - California

Application to the Administrative Office of the United States Courts for Approval as a Notice Provider Pursuant to Fed. R. Bankr. P. 2002(g)(4) and 9001(9) This Application is provided by the United States Bankruptcy Courts and may not be altered or changed in any manner. Applicant Information Firm/Company Name Address Line 1 Address Line 2 Address Line 3 City, State, Zip Contact Name Phone No. Contact E-mail Address

By completing this form, the Applicant affirms that it: 1. Understands and will comply with Rule 2002(g)(4) of the Federal Rules of Bankruptcy Procedure for providing notices to entities; Possesses the equipment, personnel and other resources for providing notices to entities, pursuant to Rule 2002(g)(4), in a timely and professional manner; Will maintain appropriate records for all mailing lists and notices received and transmitted pursuant to Rule 2002(g)(4); and Possesses ample capacity to handle anticipated noticing volumes.

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The Applicant submits the following references as to the Applicant's capability and past performance: REFERENCE #1 Firm/Company Name Address Line 1 Address Line 2 Address Line 3 City, State, Zip Contact Name Phone No. Contact E-mail Address REFERENCE #2 Firm/Company Name Address Line 1 Address Line 2 Address Line 3 City, State, Zip Contact Name Phone No. Contact E-mail Address REFERENCE #3 Firm/Company Name Address Line 1 Address Line 2 Address Line 3 City, State, Zip Contact Name Phone No. Contact E-mail Address

The Applicant should list work provided in any Bankruptcy Court district: Bankruptcy Court District Name District Name District Name District Name District Name

Authorization I am an authorized officer of the named applicant company. I declare, under penalty of perjury, that I am duly authorized to affirm the information submitted above. Name Signature Corporate Officer Title Date

Please fax the completed application to the Administrative Office of the United States Courts, Bankruptcy Court Administration Division at (202) 502-1511. A list of approved notice providers will be posted on the Judiciary's public website at www.uscourts.gov. If you have any questions regarding the status of your application, please contact the Bankruptcy Court Administration Division at (202) 502-1540.