RETAINER RECORD DATE:________________

FILE NO.______________

CLIENT’S NAME:__________________________________________ ( )NEW; ( ) OLD; ( )RETAINER

ADRESS:___________________________________________________________________________________________
_________________________________________________________________________________________________

OFFICE LANDLINE:_________________ CELLPHONE #:________________________

INRE:______________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

COURT/BRANCH/DOCKET NO.:
__________________________________________________________________________________________________

__________________________________________________________________________________________________

ADVERSE PARTIES:_____________________________________________________ CONTACT #:___________________

ADVERSE COUNSEL:____________________________________________________ CONTACT #:___________________

OTHER
PARTIES:_____________________________________________________________________________________

WITNESSES: RESIDENCE CONTACT #

1.

2.

3.

NATURE OF THE CASE: _______________________________________________________________________________

__________________________________________________________________________________________________

FEES:

ACCEPTANCE FEE:_____________________ APPEARANCE FEE:______________________________

PAYMENT:

REMARKS: _________________________________________________________________________________________

CLIENT’S SIGNATURE