CJA eVoucher Access Form

This form shall be used to request access to the CJA eVoucher system.

* denotes a required field

Personal Information

First Name:

Middle Name:

Last Name:

Bar Number:

Bar State:

List your current MDFL CJA appointed cases, if any

Primary Division:

Additional Divisions:

Ft. Myers Jacksonville Ocala Orlando Tampa

Phone Number:

nnn-nnn-nnnn *

Fax Number:

nnn-nnn-nnnn

Primary E-mail:

Your login and password will be sent to the e-mail address entered above. You must enter a valid e-mail address in order to obtain eVoucher access.

Additional E-mail:

If you would like a notice sent to another e-mail address, in addition to your primary e-mail address, please enter it in the field above.

W-9 Form:

Please select your W-9 form as a PDF file in the field above.

Firm Information - Mailing Address

Firm Name:

Address 1:

Address 2:

City:

State:

Mailing Address Zip + 4

Please enter the number that appears below:

Please click here for an audio version of the number.

By submitting this request form, the undersigned agrees to the following:

Under the CJA eVoucher Program you will be filing CJA vouchers and related documents electronically with the U.S. District Court for the Middle District of Florida. When using the CJA eVoucher Program you must abide by the Federal Rules of Civil and Criminal Procedure, CJA Guidelines, the Local Rules, and any administrative orders and policies of the Middle District of Florida.

You have full responsibility to ensure your user information, including your billing information, is accurate.

The combination of the username and password within the CJA eVoucher Program will serve as the signature of the attorney filing the voucher or documents under the afore referenced rules and procedures. Therefore, you are responsible for protecting and securing this password against unauthorized use. If you have any reason to suspect that your password has been compromised, you are responsible for immediately notifying the Clerk of Court of the suspected breach of security.

Date

Attorney/Participant Signature

Type your full name, prefixed with "s/", in the field above to acknowledge that you have read and understand the information in this document.