Legal Retainer and Authorizations Form

Legal Retainer and Authorizations Form

This Legal Retainer and Authorizations Form (the Agreement) is entered into as of Date: by and between Client Name: , Client Address: and Attorney/Law Firm Name: , Firm Address: .

Recitals

WHEREAS, Client seeks legal representation and advice from Firm concerning the matters described in the Scope of Engagement below; and

WHEREAS, Firm has represented that it is willing and able to provide legal services to Client and that the parties desire to set forth the terms of their engagement, retainer arrangement and certain authorizations necessary for representation; and

WHEREAS, Client agrees to provide information, instructions and authorizations reasonably necessary for Firm to perform legal services.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows.

1. Engagement; Scope of Services

Firm will provide legal services reasonably necessary to represent Client in the matters set forth above. Services will include legal research, preparation of pleadings and filings, negotiation, client conferences and such other tasks as the parties agree in writing. Services not described in the Scope of Engagement require separate written agreement.

2. Retainer; Fees; Trust Account

The retainer described above will be deposited into Firm's client trust account and applied against fees and expenses as billed. Client understands that deposit of funds into a trust account does not preclude Firm from drawing down fees earned in accordance with accounting rules. Any portion of the retainer not earned at termination will be returned to Client after final accounting.

Client shall be responsible for all fees, costs and expenses reasonably incurred by Firm on Client's behalf, including filing fees, deposition and investigation expenses, expert fees, courier charges and other disbursements. Unpaid balances may accrue interest at the lesser of Firm's standard rate or the maximum permitted by law.

3. Client Authorizations

Client hereby authorizes Firm, its partners, associates, employees and agents to take the following actions as necessary to represent Client in the matters described above. Client grants the authorizations below by checking the applicable boxes and providing supplemental details where requested.

Obtain medical records: Client authorizes Firm to request and receive medical and billing records relevant to the representation.
If checked, specify provider or notes:

Obtain financial records: Client authorizes Firm to obtain banking, payroll, tax and other financial records necessary for claims or defense.
If checked, specify institutions:

Settle claims: Client authorizes Firm to negotiate and recommend settlement; Firm will not accept settlement on Client's behalf without Client's written authorization unless otherwise agreed in writing.

File pleadings and documents: Client authorizes Firm to file all documents, petitions and pleadings necessary for representation and to sign Client's name on filings where permitted by law.

Retain experts and investigators: Client authorizes Firm to retain experts, consultants and investigators as necessary; Client will be responsible for associated fees and expenses.

4. Confidentiality; Conflicts of Interest

Firm will maintain the confidentiality of information received from Client in accordance with applicable rules of professional conduct. Client acknowledges that Firm has explained potential conflicts of interest and that Client has disclosed facts necessary for Firm to evaluate conflicts. If a conflict exists that materially impairs Firm's ability to represent Client, Firm will notify Client and take appropriate action consistent with professional obligations.

Client may provide a limited waiver of conflicts if appropriate. To grant a conflict waiver, check the box below and describe the scope of the waiver.

Client grants a limited conflict waiver. If checked, describe scope:

5. Client Responsibilities; Cooperation

Client shall cooperate fully with Firm, provide truthful and timely information and comply with scheduled meetings and deadlines. Client certifies that all information provided is accurate to the best of Client's knowledge and that Client has the authority to execute this Agreement and grant the authorizations herein.

6. Termination; Withdrawal; Accounting

Either party may terminate this Agreement on reasonable written notice to the other. Firm may withdraw from representation in accordance with applicable rules of professional conduct, including for nonpayment of fees, failure to cooperate or other professional reasons. Upon termination Firm will provide a final accounting and refund any unearned portion of the retainer after deducting fees and expenses incurred through the date of termination.

7. Billing; Expense Reimbursement

Firm will render periodic invoices describing services rendered and expenses incurred. Client shall pay invoices pursuant to the Billing Frequency above. Expenses may include but are not limited to filing fees, expert fees, travel, postage and recording fees. Payment may be made by check or other methods acceptable to Firm.

Client authorizes electronic payment of invoices where available and agrees to provide payment information upon request.

8. Authorization to Obtain Records; Release

Client authorizes firms, institutions and persons to release records and information to Firm as necessary for representation. Client hereby releases those parties from liability for divulging such information to Firm and acknowledges that Firm may provide copies of such records to other parties where necessary to represent Client's interests.

9. Electronic Communications

Client acknowledges that electronic communications (including email and text messages) are not always secure and consents to Firm communicating by such means unless Client notifies Firm in writing of a different preference. Client accepts the risk of such communications.

Preferred electronic contact:

10. Notices

Notices shall be effective upon delivery by hand, three days after deposit in the U.S. mail, or upon confirmed electronic transmission when sent to the preferred electronic contact above.

11. Governing Law; Venue

This Agreement will be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law principles. Venue for any dispute arising under this Agreement shall lie in the courts of that state unless otherwise agreed in writing.

12. Entire Agreement; Severability; Amendments; Waiver; Counterparts

This Agreement contains the entire understanding of the parties concerning its subject matter and supersedes prior agreements and communications. If any provision is held invalid or unenforceable, the remaining provisions shall continue in full force and effect. No amendment, modification or waiver of any provision of this Agreement shall be effective unless in a writing signed by both parties. Failure to enforce any right is not a waiver of that right. This Agreement may be executed in counterparts, each of which shall be deemed an original.

13. Certification

By signing below, Client certifies that Client has read this Agreement, understands its terms, and authorizes Firm to take the actions described herein. Client further certifies that the information provided to Firm is true and complete to the best of Client's knowledge.

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