DISCLOSURE AND CONSENT TO REFERRAL AND FEE SPLITTING
The ____________________ firm was retained on the _____ day of _____________, 20__, by ____________________ to perform the following services:
The representation is under the terms of a written agreement that provides, among other things, that the fee for the service will be ____________________________________________. A copy of the agreement is attached.
The _________________ firm desires to refer the matter to the __________________ firm to represent ______________________________ on the following terms and conditions.
The _________________ firm will pay the _________________ firm _______________________ for the services rendered by the ______________________ firm, which include:
The payment will be at the expense of the _________________ firm, and the change in representation will not be the cause of any increase in fees.
_________________________________________ ____________________________ Attorney for _________________ firm Date
_________________________________________ ____________________________ Attorney for _________________ firm Date
I understand that my case is being referred to the ________________ firm and that the __________________ firm will pay the ___________________ firm _______________________ for serves rendered by the _________________________ firm. I consent to the referral and fee splitting.
_________________________________________ ____________________________ Client Date
Warning:
These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.
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