OJIN OnLine - New Account Application

Tracking Number: 42278Date Submitted: 02/09/2010
Contact Information
Organization:
*
Physical Address:
*
Physical - City, State, Zip:
*
 ,
Mailing Address: (if different from above)
Mailing - City, State, Zip: ,
Telephone:
*
Fax:
Primary Contact Email:
*
Primary Contact Name:
*
Secondary Contact Name:
*
* Required field to process application
*Note: The primary contact will be notified of the user id and will be listed on the invoice.

Other Information
Do you represent a State Government Agency? Yes
If you checked the box above, what is the name of the agency?
Are you an Indigent Defense State Contractor? Yes
What type of web browser will you primarily be using to access OJIN OnLine?
If you have other comments, please enter them here:

Please type in the names of any users you wish to add to this account. Click the "Submit" button at the bottom when complete.
Note: each user name established, represents a $10.00 per month charge on your monthly invoice.
User #
User Name
Primary
2
3
4
5
If addtional users are required, you may add them after your application is processed.