United States District Court
Middle District of Florida

CJA eVoucher Vendor Access Form


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

* denotes a required field

Personal Information

First Name: *
Middle Name:
Last Name: *
List your current MDFL CJA appointed cases, if any
Primary Division:

Additional Divisions:   
Specialties:
Accountant
Ballistics Expert
CALR(Westlaw, Lexis, etc)
Chemist, Toxicologist
Computer (Hardware, Software, Systems)
Computer Forensics Expert
Court Reporter
Documents Examiner
Duplication Services
Fingerprint Analyst
Hair, Fiber Expert
Interpreter Translator
Investigator
Jury Consultant
Legal Analyst/Consultant
Litigation Support Services
Mitigation Specialist
Other
Other Medical Expert
Paralegal Services
Pathologist, Medical Examiner
Polygraph Examiner
Psychiatrist
Psychologist
Voice, Audio Analyst
Weapons Firearms Explosive Expert
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.

Billing Information - Mailing Address

Company Name: *
Address 1: *
Address 2:
City: *
State:
 
Mailing Address Zip + 4 *
Please enter the number that appears below:
Image 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
Vendor/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.