| First Name: |
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| Last Name: |
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| Address (optional): |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Phone: |
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| Email: |
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Type of Claim:
If unsure, see Subcategories |
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Preferred Hourly Price Range:
Remember:
1. Price varies by locale and type of claim
2. Experienced and well-regarded
attorneys are typically more expensive.
3. Some claims can be charged through a
contigency fee agreement instead of an
hourly rate. |
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Would you prefer a contingency based fee agreement, if available?
This agreement will allow the attorney to
recover a percentage of any settlement or
judgment instead of an hourly rate. |
Yes No Not sure/
No Preference |
| How close should the attorney be to your submitted address? |
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| Do have a preference on the size of the law firm representing you? |
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