WITHOUT ACCESS TO CM/ECF, YOU CAN USE THIS FORM TO SUBMIT A DOCUMENT FOR ELECTRONIC FILING.

* denotes a required field
** denotes a required field for lawyer

First Name:

Middle Name or Initial:

Last Name:

Bar Number:

State of Bar Admission:

Enter the number of the case in which you want to file:

(e.g., 8:05cv99999; if new case enter "new case")

New cases must include a motion to proceed in forma pauperis or a money order for the $402 filing fee must be mailed to the Clerk's Office.

Division:

Telephone Number:

nnn-nnn-nnnn *

Email Address:

Firm Name:

Street Address:

Suite Number:

City:

State:

Zip Code

Click on "Browse" to choose from your computer the document in PDF format (10MB maximum) you want to file.

Main Document:

Exhibits or attachments to main document:

Enter the number that appears below:

Enter the filer's full name after the "s/".

*	Date: *