DISCLOSURE AND CONSENT 1. __[Name of firm]__ was retained on __[date]__, by __[name of client]__ to __[describe services to be performed]__. 2. The representation is under the terms of __[a written/an oral]__ agreement that provides, among other things, that the fee for the service will be __[state amount or describe basis on which fee will be computed]__. __[A copy of the agreement is attached.]__ 3. __[Name of firm]__ desires to refer the matter to __[name of new firm]__ to represent __[name of client]__ __[on the same terms and conditions/describe new terms and conditions]__. 4. __[Name of new firm]__ will pay __[name of old firm]__ __[state amount or describe method of computing amount, e.g., 10 percent of net recovery]__ for __[describe services rendered by old firm]__. 5. The payment will be at the expense of __[name of new firm]__, and the change in representation will not be the cause of any increase in fees. Date: _ _ _ _ _ _ __[Typed name of old firm]__ ___[Signature of attorney]___ __[Typed name]__ Attorney for _ _ _ _ _ _ Date: _ _ _ _ _ _ __[Typed name of new firm]__ ___[Signature of attorney]___ __[Typed name]__ Attorney for _ _ _ _ _ _ I understand that my case is being referred to __[name of new firm]__ and that __[name of new firm]__ will pay __[name of old firm]__ __[state amount or describe method of computing amount, e.g., 10 percent of net recovery]__. I consent to the referral and fee splitting. Date: _ _ _ _ _ _ ___[Signature of client]___ __[Typed name]__
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Legal Forms : Set Two