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LAWYER REFERRAL SERVICE
General application and agreement

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State bar number:
Password:
 Retrieve Password
Please provide your state bar number and attorney email.
State bar number:
Attorney Email:
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>> 1. Vital Information | 2. Practice Information | 3. Practice Areas | 4. Terms and Conditions

Sections 2, 3, and 4 will be available after Section 1 is saved.
Section 1. VITAL INFORMATION
All required fields are highlighted with an *.

*State Bar Number: *Password: *Confirm Password:
The state bar number will be your username. * Password must be at least 5 characters
 
*Source:
 
Prefix:
*First Name: Middle Name: *Last Name:
Suffix:
*Attorney Email: *Email Type:
 
The fields below will be available once your username and password are created.





Please provide the firm name
*Firm Name: *Firm Size:
 
 
*Year admitted to practice in CA:
Format: yyyy 		*Year began practicing in any state:
Format: yyyy
 
An administrative/mailing address is required.
*Address1: Address2:
*City: *State: *Zip:
Wheelchair Access:
*Phone: *Phone Type: TDD:
 Numbers only. 8005551212
Fax:
 Numbers only. 8005551212
 
At least one referral address required in one of the following counties: Los Angeles, Orange, Riverside, San Bernardino, Ventura.
Primary referral address is the same as admin address.
*Referral address1: Address2:  
*City: *State: *Zip:
*Address type:   Wheelchair Access:
*Phone: *Phone Type: TDD:
 Numbers only. 8005551212
Fax:
 Numbers only. 8005551212
Referral address1: Address2:   Remove Entry
City: State: Zip:
Address type:   Wheelchair Access:
Phone: Phone Type: TDD:
 Numbers only. 8005551212
Fax:
 Numbers only. 8005551212
Referral address1: Address2:   Remove Entry
City: State: Zip:
Address type:   Wheelchair Access:
Phone: Phone Type: TDD:
 Numbers only. 8005551212
Fax:
 Numbers only. 8005551212
 

Phone numbers not associated with an office
Phone: Phone Type: TDD:    Remove Entry
  Numbers only. 8005551212
Phone: Phone Type: TDD:
  Numbers only. 8005551212

Email Addresses
*Attorney Email: *Email Type:
Additional Email: Email Type:
Additional Email: Email Type:
Additional Email: Email Type:
 
*Do you accept credit card payments from clients? Yes No  
 

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