Sample Form For Limited Representation Agreement (Page 3 of 3) in pdf

Sample Form For Limited Representation Agreement Page 3

CLIENT’S CONSENT

I have read this Notice and Consent form and I understand it. I agree that the legal services listed

above are the ONLY legal services to be provided by the lawyer. I understand and agree that the

lawyer who is helping me with these services is not my lawyer for any other purpose and does not

have to give me more legal help. If the lawyer is giving me advice or is helping me with legal or other

documents, I understand the lawyer will stop helping me when the services listed above have been

completed. The address I give below is my permanent address where I may be reached. I

understand that it is important that the court handling my case and other parties to the case be able

to reach me at the address after the lawyer ends the limited representation. I therefore agree that I

will inform the Court and other parties of any change in my permanent address.

In exchange for the Lawyers limited representation, I agree to pay the attorney’s fee

and costs described above.

Sign your name: ___________________________________________

Print your name: ___________________________________________

Print your address: __________________________________________

___________________________________________

Phone number: ___________________FAX: ____________________

Message Phone: ____________________Name: __________________

Email address: ___________________________________________

Sample Form For Limited Representation Agreement Page 3