Attorney-Client Agreement

TODAY'S DATE:                day of , 2008.

BY CHECKING THIS BOX AND PROVIDING MY ADDRESS, PHONE NUMBER, EMAIL ADDRESS, SOCIAL SECURITY NUMBER, AND BY TYPING MY NAME IN THE CLIENT SIGNATURE BOX BELOW, I HAVE SIGNED THIS DOCUMENT AS IF I HAD SIGNED IT WITH MY OWN HANDWRITING. AUTHORIZED BY SECTION §203 TEXAS ADMINISTRATIVE CODE - MANAGEMENT OF ELECTRONIC TRANSACTIONS AND SIGNED RECORDS.
Client Signature:
Address:
City: , State: Zip:
Phone: -
Email:
Date of Injury: / /
Social Security Number: - -  
Date of Birth (MM/DD/YYYY): / /