Date Submitted: 04/20/2014
OJCIN OnLine - NEW ACCOUNT APPLICATION

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:
*
Secondary Contact Email
*
* 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 government agency in Oregon?
If you checked the box above, what is the name of the agency?
Are you an Oregon State Bar member?
If you checked the box above, what is your OSB number?
Are you a Public Defense attorney?
If you checked the box above please provide the following information:
When does your contract expire?
What percentage of your practice is public defense work?
What type of web browser will you primarily be using to access OJCIN OnLine?

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 $35.00 per month charge on your monthly invoice.
User #
User NameOSB # (if applicable)
Primary
2
3
4
5
If addtional users are required, you may add them after your application is processed.


Word Verification: Type the characters you see in the picture below. Letters are not case-sensitive.