Electronic Signature Agreement

Electronic Signature Agreement
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I agree to maintain the security of the UserID and Password assigned to me by U.S. EPA
for use of the CAMD Business System, in order to prevent disclosure of this information
to anyone.

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I agree that, if I have any reason to believe that the security of the UserID or Password
has been compromised, I will immediately inform U.S. EPA by calling (202) 343-9157
or (202) 343-9168.

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I agree to maintain an email account; if any email sent to me by U.S. EPA is returned as
undeliverable, I will explain why this occurred when requested by U.S. EPA.

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I agree to notify U.S. EPA if I cease to represent the regulated entity specified below, by
sending an email to irmc@epa.gov.

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I agree that I will be held as legally bound, obligated, and responsible for any
submission I make using the CAMD Business System as I would be by making such
submission in hardcopy form with my handwritten signature as certification.

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I agree that I will be held as legally bound, obligated, and responsible for any
submission made using the CAMD Business System by an agent whom I have
authorized to act on my behalf.

SIGNATURE:
PRINTED NAME:
TITLE:
COMPANY:
EMAIL ADDRESS:
DATE:
Please send completed forms to:
Street Address (overnight mail and package delivery)
U.S. EPA
Clean Air Markets Division
1310 L Street, NW
ATTN: Karen VanSickle, Room 209
Washington, DC 20005
Telephone: (202) 343-9220

Regular or certified mail
U.S. EPA
Clean Air Markets Division
1200 Pennsylvania Avenue, NW
Mail Code 6204J, Karen VanSickle
Washington, DC 20460