Legal Business Application

LEGAL BUSINESS APPLICATION

This Legal Business Application (the "Application") is made as of by and between Applicant Name: and Legal Service Provider: .

RECITALS

WHEREAS, Applicant conducts business under the legal name and seeks legal services, counsel, and related intake screening from Provider; and

WHEREAS, Provider is duly authorized to render legal services and will evaluate Applicant's submission and associated disclosures for the purpose of establishing an engagement relationship; and

WHEREAS, Applicant submits certain corporate, financial and ownership information to permit Provider to undertake conflict checks, compliance review, and to propose appropriate terms of representation.

NOW, THEREFORE, in consideration of the mutual covenants and representations set forth herein, the parties agree as follows:

1. APPLICATION SUBMISSION; BUSINESS DETAILS

Corporation    Limited Liability Company (LLC)    Partnership    Other:

2. SCOPE OF APPLICATION AND AUTHORITY

Applicant hereby submits the information requested in this Application and authorizes Provider to use such information for conflict of interest checks, compliance screening, and to determine whether to propose and accept terms of representation. Applicant acknowledges that submission of this Application does not alone create an attorney-client relationship.

3. REPRESENTATIONS, WARRANTIES AND ATTESTATIONS

Applicant represents and warrants, and by submission of this Application certifies, that each of the following is true and correct as of the date of this Application:

Applicant is not subject to any pending bankruptcy proceeding and there are no unsatisfied judgments that would materially impair its ability to perform its obligations.

Applicant has full corporate or organizational power and authority to submit this Application and to enter into any engagement agreement resulting from acceptance of this Application.

Applicant has disclosed to Provider all known facts and circumstances that could give rise to a conflict of interest, including related parties and prior matters substantially similar to the proposed scope.

4. FEES; PAYMENT; RETAINER

If Provider elects to undertake representation following review of this Application, fees and payments shall be governed by a separate engagement letter. Applicant acknowledges that Provider may require a retainer or advance payment prior to commencing billable work. Applicant authorizes Provider to invoice the following billing contact:

5. CONFIDENTIALITY

All nonpublic information, documents and communications provided to Provider in connection with this Application shall be treated as confidential and used solely for the purposes of evaluating and, if accepted, performing the requested legal services. Nothing in this Application shall restrict Provider from disclosing information to the extent required by law, professional rules, court order, or to defend against claims arising from Provider's representation.

6. RECORDS AND DATA; PRIVACY

Applicant authorizes Provider to retain copies of records submitted with this Application. Provider will maintain reasonable administrative, physical and technical safeguards intended to protect confidential information, subject to professional obligations and applicable law.

7. TERM; TERMINATION

This Application remains effective for a period of days from the effective date set forth above. Either party may terminate discussions without liability upon written notice; any termination shall not affect obligations that accrued prior to termination.

8. INDEMNIFICATION

Applicant agrees to indemnify and hold Provider harmless from and against any and all claims, liabilities, losses, and expenses (including reasonable attorneys' fees) arising out of Applicant's misrepresentations in this Application or Applicant's failure to disclose relevant facts known to Applicant, except to the extent such claims arise from Provider's gross negligence or willful misconduct.

9. NOTICES

All notices required or permitted under this Application shall be in writing and delivered to the addresses set forth below or to such other address as the party may designate by notice in accordance with this section.

10. AMENDMENT; WAIVER; COUNTERPARTS

No amendment to this Application shall be effective unless in writing and signed by both parties. Failure or delay by either party to exercise any right shall not constitute a waiver of that right. This Application may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

11. GOVERNING LAW

This Application shall be governed by and construed in accordance with the laws of the jurisdiction of , without regard to conflicts of law principles.

12. ENTIRE AGREEMENT; SEVERABILITY

This Application constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior discussions and understandings. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

13. ACKNOWLEDGMENT AND CERTIFICATION

By signing below, Applicant certifies that the information provided in this Application is true, complete, and accurate to the best of Applicant's knowledge and that Applicant understands that Provider will rely on this information in considering whether to accept an engagement.

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