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]__
Return to Table of Contents for
Legal Forms : Set Two