APPLICATION FOR ON-LINE DATA ACCESS
NASHVILLE, TENNESSEE, CHAPTER 13

RETURN TO:

Web Access Agreements
Office of the Chapter 13 Trustee
P.O Box 340019
Nashville, Tn 37219-0664
curtism@ch13nsh.com

Company / Firm Name _________________________________________________________

Responsible Person  _________________________________________________________

Address _____________________________________________________________________

E- Mail Address __________________________________ Fax No. __________________

Telephone No. ____________________________________________

PLEASE ENROLL MY COMPANY/FIRM IN THE NASHVILLE CHAPTER 13 DATA ACCESS PROGRAM
DELIVERED THROUGH THE 13NETWORK.COM.  I
CERTIFY THAT MY COMPANY / FIRM IS A CREDITOR IN WHICH HENRY E HILDEBRAND, III
IS APPOINTED AS THE CHAPTER 13 TRUSTEE.



____________________________________________
AUTHORIZED SIGNATURE



____________________________________________
NAME  (please Print)


 directions: Please complete this form and cuplicate originals of the Nashville
 Chapter 13 Data Access On-Line Agreement and mail to the office of the chapter
 13 Trustee as noted above  After
 receiving this signed form and the executed Nashville Chapter 13 Access On- Line
 Agreement, we will return an executed original of the Areement for your records
 and will provide you with a log in and password which you and your staff must
 keep confidential. Periodically we will change your log in and password. You will
 be notified in advance  by e-mail and will be required  to send to the Trustee a
 signed reaffirmation of on-line access agreement by an authorized representative
 of your company. You are responsible for maintaining the security of our system
 by keeping login and password confidential. Use of the website and logs of connections
 are maintained and reviewed.

 
ON-LINE AGREEMENT _