Fillable OJCIN Online Customer Information (Please Print Clearly) (Oregon)

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OJCIN Online Customer Information (Please Print Clearly) (Oregon)

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OJCIN Online Customer Information Form_New (08.29.2017) Page 1 of 3
OJCIN Online Customer Information
(Please Print Clearly)
Entity/Business Name: ___________________________________________
Type of Business: ____________________________________ Date: _____________
Tax ID (SSN for individuals)*: ___________________________________
Mailing Address:_______________________________ Phone: _______________________
________________________________
City, State, Zip ________________________________
Primary Contact
Name: _ ______________________ Title: _ _ ____
Phone: __________________________________ Division: _____________________
Email:
Additional contact(s)
(In addition to the Primary Contact, these additional contacts will have the authority to reset passwords,
add/modify/remove users, and update customer information for the subscriber account.)
Name: ______________________________________ Title: ______________________
Phone: ______________________________________ Division: ______________________
Email: _______________________________________
Name: ______________________________________ Title: ______________________
Phone: ______________________________________ Division: ______________________
Email: _______________________________________
Accounting Contact (if different than Primary Contact) – for billed customers only
Name: ______________________________________ Title: ______________________
Phone: ______________________________________ Division: ______________________
Email: _______________________________________
Invoice delivery method (please select one) _____ Mail only _____ Email only _____ Both
OJCIN Online Customer Information Form_New (08.29.2017) Page 2 of 3
Indicate if you require access to the Appellate Court System.
Yes - Create ACMS UserID
No - ACMS Access is not needed.
Please select your Entity/Business Category
Background /Research
Collections
Data Reseller**
Finance/Banking
Government
Insurance
Legal Aid/Legal Non Profit
Media
Oregon Law Firm*** # of attorneys in firm _________
Out of State Law Firm # of attorneys in firm _________
Personal
Private Investigator
DPSST- PIID#__________
Process Server/Legal Service
Real Estate/Property Management
Title Company
Other (specify): ______________________________________
**"Data Reseller" means a subscriber who accesses or uses the OJCIN system for purposes of obtaining OJD
data to provide all or part of the OJD data: (i) to third parties as part of its business as a Data Broker (defined
below); (ii) for inclusion in a database that is accessible by third parties; or (iii) to third parties who are not the
End Users (defined below) of the data. “Data Broker” means an individual or entity, other than a title
company, whose business is collecting and aggregating personal information and data on individuals and
entities, then reselling or licensing such collected or aggregated information and data to third parties. “End
User” means the ultimate consumer of the data, who uses the data solely for their own internal purposes,
and who does not further redistribute the data.
***Oregon Law Firms:
Please provide OSB numbers for each attorney in firm on the next page.
Indicate if your practice includes the following restricted case types:
Juvenile (Dependency and/or Delinquency)
Mental Health
*Your Social Security Number/Tax ID number is requested for the purpose of verification of your identity and review of your
application for an OJCIN Online subscription. Provision of your Social Security Number/Tax ID is voluntary. This information is
confidential and can be used for collection purposes.
OJCIN Online Customer Information Form_New (08.29.2017) Page 3 of 3
Oregon State Bar Members
Attorney Name
OSB #
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OJCIN Online Customer Information (Please Print Clearly) (Oregon)

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Completed 14 November 2020

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