Fill and Sign the Monthly Retainer Agreement Form

ADDENDUM TO RETAINER AGREEMENT The undersigned acknowledges that he/she previously entered into a written retainer agreement with ___________ dated _________________ which requires monthly payments of all fees and costs incurred. I acknowledge my current outstanding balance to the ___________ exceeds $ ___________ and I am currently unable to pay the outstanding balance in full on a monthly basis. I have reviewed all monthly itemized billing statements and agree the billings are accurate; correctly reflect the fees and costs incurred; and agree the services rendered were appropriate and necessary. I further acknowledge that my inability to pay my outstanding balance is not an indication I dispute the accuracy, necessity or quality of services rendered. I agree to resolve any disputed fees, costs or services within 30 days of receipt of the monthly statement itemizing said fees, costs or services. In lieu of the previous agreement to pay my outstanding balance in full, I agree to make the following monthly payments; THIS IS A LEGAL, BINDING CONTRACT BETWEEN YOU AND US. NO PROVI - SIONS HEREOF SHALL BE CONSIDERED WAIVED OR AMENDED EXCEPT IN WRITING BY BOTH OF US. WE AGREE THAT IF THERE IS ANY TERM HEREIN THAT IS DEEMED ULTIMATELY TO BE UNENFORCEABLE, THAT SAID TERM OR TERMS SHALL BE SEVERED OFF AND THE REMAINDER OF THE AGREEMENT PURSUANT TO MINNESOTA STATE LAW SHALL CONTINUE IN FULL FORCE AND EFFECT. BEFORE SIGNING, PLEASE READ THIS AGREEMENT CAREFULLY AND BE SURE YOU UNDERSTAND ALL OF THE CONTENTS. IF THERE IS ANYTHING YOU DO NOT UNDERSTAND, ASK ABOUT IT. READ, APPROVED AND ACCEPTED: By:___________________________ SOCIAL SECURITY NO.: WORK TELEPHONE NO.: HOME TELEPHONE NO.: DRIVER'S LICENSE: - 1 -