Client Information Sheet

This is not legally binding unless accepted and signed by an attorney. If we accept your submission, we will provide a signed copy of your submission.

Name*

Date*

Date of Birth*

Address*

Street Address City State ZIP Code

Home Telephone

Work Telephone

Cell Telephone

Email Address*

Fax

Social Security Number

Occupation

Employer Name

Employer Address

Street Address City State ZIP Code

Are you a business client?

Are You a Business Client?

Name of Business*

Names of Principals*

Partners, shareholders, etc.

Entity Type*

Corporation

Sole Proprietor

Limited Partnership

General Partnership

Limited Liability Company

Other

Business Address*

Street Address City State ZIP Code

Spouse Name*

Prior Names of You and Spouse*

Maiden name or prior business names. This is necessary to check for conflicts of interest.

Spouse Address is the same as mine

Spouse address is the same as mine

Spouse's Address*

Street Address City State ZIP Code

Nearest relative or friend not living with you who can be contacted in case of an emergency

Relative Name*

Relative Phone Number*

Relative's Address

Street Address City State ZIP Code

Purpose of Consultation*

Opposing Parties

Add up to 3 opposing parties.

Opposing Party

Include prior names

Attorney

Telephone

Address

Street Address City State ZIP Code

Opposing Party

Include prior names

Attorney

Telephone

Address

Street Address City State ZIP Code

Opposing Party

Include prior names

Attorney

Telephone

Address

Street Address City State ZIP Code

Where Did You Hear About Us?

Internet

HLP Website/Live Chat

Former/Current Client

ARAG or Hyatt/MetLife legal insurance

Referral

Other

Referral From

Consent*

I agree to the Terms and Conditions*

HOWARD, LEWIS & PETERSEN, a professional corporation ("Lawyers"), agrees to represent the client identified above ("Client") and Client employs Lawyers on the following terms and conditions:

The representation is limited to the purpose above, unless otherwise agreed.

Client appoints Lawyers as Client’s attorneys to represent Client in this matter and gives to Lawyers full authority to act on behalf of Client in handling this matter. Client shall promptly comply with all reasonable requests made by Lawyers, including providing information necessary to properly evaluate and prosecute Client’s claims.

Client will keep Lawyers informed of any change in the contact information for Client. Client will promptly inform Lawyers of any change in Client’s circumstances that may affect Client’s case.

Client shall pay to Lawyers a reasonable fee, based primarily on the time expended and expenses incurred, but also based on the factors which define a reasonable fee as stated in the Utah Rules of Professional Conduct. Time of Lawyers will be charged and billed at the usual and ordinary rate set by Lawyers, which may be changed from time to time. Expenses include all out of pocket expenses other than attorney fees, such as filing fees and other court expenses, deposition costs, and all other expenses necessary in connection with the representation of Client. Interest shall accrue on any statements not paid within 30 days at the rate shown on the billing statements (currently 1.5 % per month (18% per annum)). For contingent fee cases, the fee arrangement will be stated in a separate agreement, but all other provisions of this agreement will apply.

As provided by law, Lawyers have and claim a lien upon Client’s cause of action or counterclaim and any real, personal, or intangible property that is the subject of or connected with the work performed for the client, as security in the event of nonpayment by Client. Client consents that Lawyers may file or record appropriate documents to give notice of the lien. In the event of non-payment or other breach by Client, including if Lawyers are required to enforce this agreement by bringing a lawsuit against Client, Lawyers may recover all costs of enforcing this agreement, including a reasonable attorney fee.

Retainers are not estimates of fees. All retainers paid will be immediately applied to Client’s account as work is performed by Lawyers.

Client acknowledges that Lawyers have not promised any particular result. While Lawyers will devote their professional expertise on behalf of Client, Lawyers cannot control the result.

At the conclusion of representation in this matter, Client should retrieve Client's file for storage and safekeeping. Any files left with Lawyers may be physically destroyed after one year.

An individual signing this agreement on behalf of an entity warrants that he/she has authority to bind the entity and personally guarantees payment and performance of the entity’s obligations under this agreement. I declare that the information I have provided is complete and true and that I have included the names of applicable business entities and principals on the front side of this form. I authorize Lawyers to verify any information that I have listed. I also authorize Lawyers to obtain a copy of my credit report to determine creditworthiness.

Signature*

Date*