CONTINGENT FEE, SHORT FORM

 

I, _____________, [on behalf of _______________,] hereby retain ___________ to make an investigation of and represent me [on behalf of ___________], in my [his/her] claim for personal injuries sustained by __________________ on or about __________________ at the intersection of    _____ in the City of _____, County of _____, State of _____.

I agree to pay _______, as compensation for services rendered, a Contingent Fee of ____% of the amount finally awarded either by way of settlement, trail or appeal. No settlement of [_____’s] claim may be made without my express authorization.  I acknowledge that ________ has explained to me the right to engage any attorney(s) of my choice and that I have the choice of alternative fee arrangements for compensating ________.

If my case is resolved on a structured basis (a lump sum cash payment plus periodic cash payments), I further agree that the fee payable to _________ shall be payable in full on the date of the first cash payment and shall be based upon the then present cash value of the entire structured settlement.

I will also reimburse __________ for any out-of-pocket expenses advanced by it for investigation or litigation on my [_________’s] behalf. These expenses include, but are not limited to, filing fees, investigators, expert witness fees, depositions, court costs, travel and other out-of-pocket expenses. Costs exceeding $100 may be billed directly to me and I agree to promptly and directly pay these costs.  I will send notice to____________ of all such payments.  Otherwise, ___________ agrees to contact me prior to advancing any cost exceeding $300.

I agree to pay ___________ a deposit of $_____, as a partial advance against anticipated costs and disbursements.  ___________ will send me monthly itemized statements of costs and disbursements, which once the deposit is depleted; I agree to pay within thirty days of the invoice date.  I understand that __________ reserves the right to charge me interest, not to exceed _____% per annum, on any bill outstanding for more than thirty days.  This deposit will be refunded to the extent it has not been utilized in this matter.

In the event that a recovery is made by settlement, trial or appeal, the expenses shall be deducted from my share of the recovery after the attorneys’ fees have been calculated and deducted from the recovery. I understand that a recovery cannot be guaranteed and that I remain responsible for any out-of-pocket expenses regardless of the outcome.

I understand that in the event that ____________ concludes at any time that there is not sufficient likelihood of recovery to justify further time and effort, ____________ shall have the right to withdraw from employment, which shall terminate their right to compensation for professional services, except for any outstanding costs and disbursements.

______________acknowledge that if no recovery has been made upon the final conclusion of my claim, ___________ will not be entitled to any compensation for professional services rendered, and I will have no obligation beyond reimbursement of costs.

Date: _________________                            __________________________________

                                                            [Name] [On behalf of_________________________]

Date: _________________                            __________________________________

                                                               [Name]