Enter law firm name

Enter Street Address of Law Firm

Enter City, State, Zip Code of Law Firm

Attention: Enter Individual Attorney's Name

Dear Enter Salutation:

We retain your law offices to represent us in regard to a claim against Enter Name of Adverse Party, related to Enter Brief Description of Nature of the Case.

Your fee shall be contingent on collection from the responsible parties, and shall be as follows:

Enter Percentage Fee - Recovery Before Suit (in Numerals) per cent for recovery before suit;

Enter Percentage Fee - If Suit is Required (in Numerals) per cent for recovery after suit is instituted;

Enter Percentage Fee - If Appeal is Required (in Numerals) per cent for recovery if an appeal is required;

Out of pocket costs reasonably expended and with prior approval of us will be deducted from settlement.

If this arrangement is acceptable, please sign and return a copy of this letter to us.

Sincerely,

Enter Sender's Name (Signatory of Letter)

Accepted: Attorney's Name