Free Electronic Notice Registration - North Dakota

UNITED STATES BANKRUPTCY COURT DISTRICT OF NORTH DAKOTA

Electronic Service Registration and Consent Form for Debtor(s)

Name Last, First, MI: Last 4 digits of SSN/Emp ID: Case Number: Adversary Case Number: Mailing Address:

_______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________

Telephone Number: E-mail Address(es):

_______________________________________________________ _______________________________________________________

REQUESTING TO RECEIVE ELECTRONIC NOTIFICATION OF FILING CONSTITUTES:

I consent to service by electronic means when permitted under applicable rules and the Court's Electronic Case Filing Administrative Procedures.

Dated:_____________________________

__________________________________ Applicant Name (please print)

________________________________ Applicant Signature