Attorney Agreement for Injury Collection

I, _________________________, direct __________________________, to pay from

the proceeds of any recovery related to or arising out of that incident occurring on
_____________________ in which I was injured, such sums as may be due and owing
to _______________________ for services which have been rendered or which will be
rendered, up to a total amount of $_______________.

NOTICE: _________________________ is nevertheless liable for the fees due to

_______________________ if no recovery is made.

It is understood that I shall retain all sums of money over the funds due
______________, which as referred to above, cannot exceed $ _____________.

Dated: _________________

______________________________________
_________________________ By Attorney

______________________________________
_________________________ By Injured Party

Witness:

______________________________________
 Attorney Agreement for Injury Collection
Review List

This review list is provided to inform you about this document in question and assist you
in its preparation. Personal injury (“PI”) cases are very lucrative for attorneys. This
document gives the edge to the injured party by limiting the attorney’s payment to a fixed
sum. When shopping for a PI attorney, consider first comparing offers by the terms of
their services. In other words, first negotiate the best terms (e.g., lowest percentage of
recovery, and so on) then select the attorney, rather than selecting first and just
accepting their contract.