BHBA: Form D

CLIENT’S REQUEST FOR RESOLUTION OF A FEE DISPUTE

Beverly Hills Bar Association, 300 S. Beverly Drive, Suite 201, Beverly Hills, CA 90212 310.553.6644

1. Petitioner’s Name: (1)

Petitioner’s Name: (2)

Address:

City:                                                      State:                                            Zip Code:

Telephone: (        )                                                                 Fax: (         )

2. Attorney with whom you are having the dispute:

Name:

Address:

City:                                                      State:                                           Zip Code:

Telephone: (        )                                                                Fax: (        )

3. Attorney representing you in this dispute, if applicable:

Name:

Address:

City:                                                     State:                                           Zip Code:

Telephone: (        )                                                                 Fax: (        )

4. ***IMPORTANT*** You must give a detailed written description of the fee dispute on a separate sheet of paper. Submit a total of one original and four copies of this Request form for a grand total of five. Each of the five Request forms should have any and all additional information attached. DO NOT send originals of attachments.

5. What type of case was the attorney retained for that resulted in the fee dispute? For example: family law, immigration law, business law, etc.

6. Do you have a written fee agreement?                                                                                          Yes      /     /    No      /    /
**If so, attach a copy of the agreement with your request for arbitration. **

7. If you answered yes to question #6, do you have an arbitration clause in the agreement:   Yes      /     /    No      /    /
If you do have an arbitration clause in your fee agreement, please read Rule 4.A.

8. Did you hire the attorney before January 1, 1979?                                                                     Yes      /     /    No      /    /

9. (A) Has the attorney filed suit in court to collect fees?                                                               Yes      /     /    No      /    /
**If the attorney has filed a suit in court, enclose a copy of the suit. **

(B) If the attorney has filed suit, when were you served with the suit?

(C) If the attorney has filed suit, have you answered the suit in court?                                         Yes      /     /    No      /    /

10. (A) Have you received a “NOTICE OF CLIENT’S RIGHT TO ARBITRATION” form, which informs you about the 30-day limit to arbitrate?                                                                                                                                      Yes      /     /    No      /    /

(B) If yes, you must attach a copy. Please indicate when you received it:

11. In the event that you are awarded a refund, which can include any filing fees you may pay to BHBA, who do you think is the attorney responsible for paying you? (NOTE: You must name an individual, not a firm).
Name:

12. Unless both you and the attorney agree to BINDING ARBITRATION, the arbitration will be non-binding. For clarification, please review Rules 4 and 5.
                                                   You Must Choose One:    Binding    /    /       Non-Binding    /    /

13. Amount in dispute is the combined amount of any fees you have already paid the attorney that you feel should be refunded to you, plus any unpaid fees you feel should not be paid.

A) How much have you already paid the attorney?                                                                               $

B) Are you seeking a REFUND of any of this?                                                                                     Yes      /     /    No      /     /

If so, how much?                                                                                                                                         $

C) 1. How much is the attorney now claiming you owe as the unpaid balance, if any?                  $

2. How much of this do you feel should be paid?                                                                                   $

3. Subtract C.2 from C.1 and enter here:                                                                                              $
D) Add the total in 13.B and 13.C.3 and enter total amount in dispute                                             $

14. Filing Fees: The filing fee must be paid at the time of filing this request and is based on the total amount in dispute. If there is a valid arbitration clause in your fee agreement pursuant to Rule 4.A, the parties split the filing fee equally and you should submit half of the total amount due. If there is no arbitration clause, or there is an invalid arbitration clause pursuant to Rule 4. A, please submit the full filing fee. Refer to Rules of Procedure, #13 regarding possible additional fees/costs.

     /    / If the amount in dispute is less than $10,000 you pay 5% of that amount.             Amount enclosed: $____________

     /    / Or, if the amount in dispute is more than $10,000, you pay 7% of that amount.   Amount enclosed: $____________

15. If you choose BINDING ARBITRATION and the amount in dispute is over $10,000 or NON-BINDING and your case is over $20,000 in dispute, it may be heard by a 3-arbitrator panel. However, if you both agree, it may be still heard by one arbitrator. NOTE: if the matter does not qualify for three, one arbitrator will always be assigned.
     PLEASE CHECK ONE: THREE ARBITRATORS /    /      ONE ARBITRATOR /    /

16. You may request that the sole arbitrator or one member of a panel be experienced in either civil or criminal law, depending on the area of your underlying case. Please check one:
     /    / I want an arbitrator experienced in criminal or civil depending on the area of my underlying case
     /    / I do not have a preference

17. If you both agree, you are also entitled to up to four hours of mediation time. If the matter does not resolve through mediation it will then proceed to arbitration. Please refer to the Mediation Rules of Procedure. Indicate your choice:
     /    / I WOULD LIKE TO MEDIATE      /    / I DO NOT WANT TO MEDIATE THIS DISPUTE.

18. I acknowledge receipt of the BHBA Rules of Procedure and agree to be bound by them. I declare under penalty of law that everything I have stated is true to the best of my knowledge.

________________________ __________________________________________________________________
DATE PETITIONER’S SIGNATURE (COUNSEL MAY NOT SIGN FOR CLIENT)

_______________________ ___________________________________________________________ DATE PETITIONER’S SIGNATURE (if more than one)

BHBA FORM D REVISED APRIL 2002