Fill - Free fillable GENERAL AUTHORIZATION LETTER PDF form

GENERAL AUTHORIZATION LETTER

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Dear LegalShield℠ member:

You requested that we write a letter or make a telephone call to an opposing party on your behalf. In

order for us to do so, please carefully read this letter and the Request for Letter or Telephone Call that

follows, then complete the requested information, sign the form and return it

to us. YOU MUST FULLY

COMPLETE EACH BLANK LINE AND PROVIDE ALL

REQUESTED INFORMATION

BEFORE WE CAN CONTACT THE OPPOSING

PARTY ON YOUR BEHALF.

Sincerely yours,

Friedman, Framme & Thrush, P.A.

Request for Letter or Telephone Call

Date: __________________________________ To: Friedman, Framme & Thrush, P.A.

Attention/Attorney: __________________________________________________________________

Email: mail@fftlaw.com - or- Fax: (410) 559 9009

From: _____________________________________________________________________________

State: _________ Intake #: ____________ LegalShield Membership #: ______________________

My Mailing Address:

______________________________________________________________________________

I have discussed my legal matter with you and request that you send a letter or make a telephone

call to an opposing party on my behalf. This request is also my authorization for you to do so in

accordance with my consultation with you and based on the information contained below.

I understand that if this request involves review of my personal health information and is subject to the

Federal Health Insurance Portability and Accountability Act (Health Information Privacy Rule), I hereby

authorize Friedman, Framme & Thrush, P.A. to obtain and release this information as appropriate or

helpful to comply with this request.

Finally, I confirm that this request does not relate to enforcing lien rights since specific time frames may apply.

I understand that if I wish to enforce specific lien rights that I must contact your office to discuss how to protect

and enforce these rights and that if I do not do so, I may lose any such rights.

1. The full name and address of the party you are to contact is:

________________________________________________________________________________________

2. If the party to be contacted is a business, the name of the business and its owner or representative is:

________________________________________________________________________________________

3. The facts, dates and details that relate to this request are:

________________________________________________________________________________________

(Please attach another sheet if more space is needed)

4. I request that you make the following demand on the opposing party and include in this the principal amount

owed as well as any applicable interest.

________________________________________________________________________________________

5. Attached are all contracts, prior letters, invoices, estimates, photos or other documents that I

have relating to my claim. Please limit this to 10-15 pages depending on your contract, unless

otherwise advised by attorney.

6. The opposing party (check one) ☐IS or ☐IS NOT a member of LegalShield, or ☐I DO

NOT KNOW if the opposing party is a member of LegalShield.

7. I understand that you (check one) ☐WILL or ☐WILL NOT send a copy of the draft letter

to me to review before it is sent to the opposing party. I further understand that if you send a

draft to me that you will not send a final letter until you receive my comments on your draft.

8. I want the final letter sent by (check one) 1) Delivery Confirmation (tracking but no signature); or 2)

Certified Mail Return Receipt Requested (CMRRR); or 3) neither, just regular mail. I understand that your

office charges $7 for option 1); or $15 for option 2); or $0 for option 3). If I am requesting options 1) or 2),

I have contacted the firm or made payment at www.fftlaw.com by credit card.

 To make a payment online, please go to our website at www.fftlaw.com and click the pay a

bill tab. Choose the option to “pay a legal fee or costs”. It will prompt you to accept the

terms and enter in your credit card information. You may also call our 800 number to pay by

credit card over the phone.

9. Please send my copy of the draft and/or final letter to me by (choose one):

a. Email to: _______________________________________________________________

b. Fax to: __________________________________________________________________

c. Regular mail to: __________________________________________________________

_____________________________________________________________________________

The details I have provided are accurate to the best of my information and belief.

______________________________________________ _______________________

Signature Date

Important note to members: If we prepare and send a letter on your behalf, we will

do so under the terms of your LegalShield membership contract and will rely on the information

contained in your Request to do so. We will make every effort to complete and send the letter

within three business days from receiving the Request from you (two days for small business

members). We will send you a copy of any letter. Our representation of you in this matter will

end when we send the letter or make the telephone call. However, please call with any

additional questions you may have or if you would like us to take further action. We would

appreciate your advising us of any response you receive from the opposing party.

Fill Online, Printable, Fillable, Blank GENERAL AUTHORIZATION LETTER Form

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Fillable GENERAL AUTHORIZATION LETTER

Fill Online, Printable, Fillable, Blank GENERAL AUTHORIZATION LETTER Form

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