Request Access to eVouchers – Vendor 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 FLSD CJA Appointed Cases, if any
Primary Division

Specialties

Please upload your W-9 form as a PDF file

Phone Number ###-###-#### *
Fax Number ###-###-####

Primary Email *
Your login and password will be sent to the Primary email address entered above. You must enter a valid email address in order to obtain eVoucher access.

Additional Email
If you would like a notice sent to another email address, in addition to your primary email address, please enter it in the field above.

Billing Information - Mailing Address
Company Name *
Address 1 *
Address 2
City *
State *
Zip *

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 Southern 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 United States District Court of the Southern 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 vendor 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.