Date: ex.mm/dd/yy    Attorney:

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Adverse Party:

To the best of your knowledge, has Clark and Feeney ever represented this party? Select Yes No If so, approximate date: ex. mm/dd/yy

Can you think of any reason Clark and Feeney may have a conflict of interest in this regard?:

Have you ever been involved in a matter in which Clark and Feeney has represented the opposing party?: Select Yes No If your answer is Yes, who was Clark and Feeney's client, what was the issue(s) involved, and when did this representation occur? Date: ex. mm/dd/yy

Do you waive any conflict that Clark and Feeney may have if this law firm were to represent you? Select Yes No

REFERRED TO CLARK AND FEENEY BY:

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I AGREE TO PAY THE ENTIRE BALANCE DUE TO, INCLUDING ACCRUED INTEREST ON ACCOUNT.

2% Per Month (24% per annum) Service Charge on all accounts over 30 days.
20% Administrative Charge on costs advanced.

I AGREE TO PAY FOR THE INITIAL CONSULTATION UNLESS THIS IS THE TYPE OF CASE THAT WILL BE HANDLED BY MY LAWYER ON A CONTINGENT FEE BASIS. THE TYPES OF CASES THAT ARE HANDLED ON A CONTINGENT FEE BASIS ARE CASES WHERE A PERSON WAS INJURED IN AN AUTOMOBILE ACCIDENT OR INJURED AT WORK. I UNDERSTAND ALL OTHER TYPE OF CASES HAVE A FEE FOR THE INITIAL CONSULTATION AND I AGREE TO PAY MY LAWYER FOR HIS/HER TIME AND SERVICES INCLUDING PREPARATION OF VARIOUS LEGAL DOCUMENTS.

Type of case:

Field of Law (category): Select Category Accidents - personal injury/property damage Agricultural/Livestock Bankruptcy Business, corporate & partnership Civil Rights Collections Condemnation Criminal Divorce & Family Driving While Intoxicated General Practice Government & Finance Insurance Labor Litigation - General Litigation & Construction Law LOID Medical Malpractice Municipal Government & Finance Product Liability Real Estate Social Security Taxes Traffic Violations Trial & Appeals Wills, Estate Plan & Probate Workmen's Compensation

Adverse Party:

Fee Arrangement:

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