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Full Name

Phone *

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Email *

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State or States of Law Licensure of Supervising Lawyer *

Your State Bar Number

Law Firm Name (if any) *

Address

Business Address *

City *

State *

Name of Your Client *

Name of Opposing Party or Parties *

If Case Is Pending Insert Case Number

State or Federal Jurisdiction Where Case Is Pending Or Where You Wish Case To Be Filed *

What Do You Want Us To Do? *

How soon do you need this assignment completed by? *

Please Upload Any Relevant Case Docs

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