BHBA: Form E

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

1. Respondent: (1)

Respondent: (2)

Address:

City:                                                                State:                            Zip Code:

Telephone: (      )                                                       Fax: (      )

2. Client 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 Reply form, for a grand total of five. Each of the five Reply forms should have any and all additional information attached. DO NOT send originals of attachments.

5. What type of case resulted in the fee dispute? For example: family, immigration, etc.


6. (A) Do you have a written fee agreement?                                         Yes    /    /      No    /    /
If yes, attach a copy. If no, explain your verbal agreement on separate sheet.

(B) If yes, 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.]

7. (A) Was your fee arrangement:                                                            Hourly    /    / or Contingent   /    /
(B) If contingent, is the matter concluded?                                               Yes    /    /      No    /    /
(C) Are you the client’s:                                                  First attorney? /    /    or Successor attorney? /    /

8. In accordance with Business and Professions code 6203(d), who is the responsible attorney?

Name:

9. Unless both sides agree to BINDING ARBITRATION, the arbitration will be non-binding

You Must Choose One:                                                  Binding /    /      Non-Binding /    /

10. Amount in dispute:

A) What is the total amount of the costs/fees charged to the client?                              $______________

B) How much have you already been paid?                                                                      $______________

C) What is the outstanding balance?                                                                                 $______________

11. Filing Fees: The client has indicated an amount in dispute and paid a filing fee based on that amount. Refer to Rules of Procedure, #13 regarding possible additional fees/costs.

A) If you believe the amount in dispute is higher than indicated by the client:

1. How much are you increasing the amount in dispute?                                         $___________________

2. Attach an explanation of the increase for review by the arbitrators.

3. Additional filing fees on the increase must be paid at this time. Please check one:

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

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

12. 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, one arbitrator may still hear it. NOTE: if the matter does not qualify for three, one arbitrator will always be assigned.
PLEASE CHECK ONE:                                 THREE ARBITRATORS /    /    ONE ARBITRATOR /    /

13. 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 TRY MEDIATION.

     /    / I DO NOT WANT TO MEDIATE THIS DISPUTE.

14. 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                            RESPONDENT’S SIGNATURE (COUNSEL MAY NOT SIGN FOR CLIENT)


DATE                            RESPONDENT’S SIGNATURE (if more than one)

BHBA FORM E REVISED APRIL 2002