Attorney Application
The term Law Firm
includes sole practitioner, partnerships, professional corporations,
etc.
1. Identification
Name of Law Firm:
Fed ID # or SS#:
Number of Attorneys in Firm:
Street Address:
City:
State: Zip:
Telephone
#:
Fax #:
Email:
2.
Attorneys
Please provide the following information for each
attorney in the Law Firm who would be providing legal services to the
members of our group. (After submitting and printing this form you can
attach a separate page for each attorney)
Name:
Office Address:
Phone
Number:
County:
Legal Education:
(Law School from which degree(s) received and date
awarded)
Bar Admission:
State:
Date:
State: Date:
U.S. District Court
(Identify): Date:
Years in practice in this community:
Languages spoken in firm:
Have you ever been reprimanded, censured, suspended
or otherwise disciplined by any bar or court? Yes No
If yes, describe the circumstances:
Do
you carry malpractice insurance? Yes No
If yes, how much?
Name
of carrier:
3. Geographic
Service Area
Indicate the approximate geographic area for which
each office of the Law Firm would be able to provide legal services under
the program (in a particular city or county; in several cities or
counties; anywhere in the State; in several states, etc.)
4.
Practice
Indicate when which of the following substantive areas
the Law Firm would be qualified to provide legal services:
CORE
AREAS
Administration Proceedings: Yes No
Advice and
Consultation: Yes No
Civil Litigation & Consumer
Complaints: Yes No
Criminal Matters: Yes No
Domestic Relations: Yes No
Financial
Counseling: Yes No
Landlord & Tenant Matters: Yes No
Personal Injury: Yes No
Real Estate
Transactions: Yes
No
Traffic Matters: Yes No
Wills & Estate Planning: Yes No
OTHER
AREAS:
Please indicate, and explain,
whether the Law Firm has a conflict of interest in any of the core
areas.
REPRESENTATION
BY LAW FIRM
Has the Law Firm ever participated in a prepaid or other
group legal service program? Yes No
If
yes, provide the name of the program, dates of participation and
description of the extent of participation.
State
any other information which you believe makes your Law Firm particularly
qualified to participate in Group Legal Service Plans ( such as relevant
work experience, community activities, etc.):
Company History &
Profile
| What Is A Group Legal
Benefit?
| Why Group
Legal?
How To Administer & Deliver
Legal Services
| How To Fund A Group Legal
Plan
How It All Came
About
| Plan Options | Legal Services Plan
Proposal
Contact
Us
info@grouplegal.com |