Fill and Sign the Contingency Retainer Form

ATTORNEY FEE LETTER – CONTINGENCY In consideration of the legal services to be rendered by The Law Office of ________________ (hereinafter referred to as "Law Firm") for any claim that ______________, (hereinafter referred to as "Client"), may have against the parties responsible for injuries and/or damages sustained by the client on or about the ______ day of______________, 20___, the client does employ said Law Firm to commence and prosecute such claim. Client agrees to pay, and hereby assign to Law Firm, a lien of ___% of all amounts recovered on behalf of Client by settlement before the filing of a lawsuit or other court action, ___ % of all amounts recovered after the filing of a lawsuit or other court action but prior to trial; and ___% of all amounts recovered or awarded upon trial or if settled after preparation for trial by attorney. A retainer fee of _______________ Dollars, ($_________), shall be paid upon execution of this agreement, which sum shall be credited against any recovery, but, in the event of no recovery, shall not be refunded. Law Firm and Client agree that no attorney - client relationship shall exist until Law Firm has been paid the initial retainer fee. All necessary costs and expenses in the prosecution of the case shall be the responsibility of the Client. If Law Firm advances funds on behalf of the Client for any costs or expenses, Client agrees to reimburse Law Firm for such advancements. All expenses and charges of any nature made in conjunction with the case are not litigation costs and will be paid by Client. In the event of a recovery, Client agrees that Law Firm may pay any of these unpaid bills from Client's share of the recovery. If Client recovers nothing, it is understood that Law Firm is not bound to pay any of these expenses. Law Firm, in its absolute discretion may withdraw at any time from the case upon notice to Client if investigation discloses no basis for further action on behalf of Client, or if there is no - 1 - insurance coverage. Associate counsel may be employed at the discretion and expense of Law Firm. Client agrees not to compromise the claim without the Law Firm's consent and Law Firm is not authorized to do so without the consent of the Client. The fee for services rendered by Law Firm does not include the perfecting of an appeal on behalf of the client or the representation of the Client if an appeal has been perfected by the adverse party. Fees for appeal shall be subject to renegotiation between Law Firm and Client. Client agrees to keep the Law Firm advised of his whereabouts at all times and to cooperate in the preparation and trial of the case, to appear on reasonable notice for depositions and court appearances, and to comply with all reasonable requests made of him in connection with the preparation and presentation of this case. Client hereby authorizes Law Firm to provide all information, including doctor's reports, hospital records, etc., and any and all pictures to the insurance company or the attorney for the adverse party. NO REPRESENTATION HAS BEEN MADE REGARDING WHAT AMOUNT, IF ANY, CLIENT MAY BE ENTITLED TO RECOVER IN THIS CASE, NOR HAVE ANY WARRANTIES BEEN MADE REGARDING THE OUTCOME OF THIS MATTER. Date: _________________________ ________________________________________ ________________________________________ NOTE: THIS IS YOUR AGREEMENT. IT PROTECTS BOTH YOU AND YOUR ATTORNEY. IT IS DESIGNED TO PREVENT MISUNDERSTANDINGS. IF YOU DO NOT - 2 - UNDERSTAND IT OR IF IT DOES NOT CONTAIN ALL THE AGREEMENTS WE DISCUSSED, PLEASE DISCUSS IT WITH ME. - 3 -