Login

Fillable Printable Letter Of Authorization Sample Template 337516

Fillable Printable Letter Of Authorization Sample Template 337516

Letter Of Authorization Sample Template 337516

Letter Of Authorization Sample Template 337516

Page 1 of 3
337516_5
Please type or print
GE
NERAL AUTHORIZATION LETTER
Dear LegalShield
SM
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,
Framme Law Firm PC
Request for Letter or Telephone Call
Date:
To: Framme Law Firm, PC Attention/ Attorney:
Email: [email protected] - or- Fax #:
All attorneys have direct fax numbers; please fax to the number given to you by the attorney.
If you have trouble with that number, you can fax to our firm’s main fax number (800) 930-3150.
You can always mail the documents via regular mail.
From:
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 Framme Law Firm, PC to obtain and release this information as
appropriate or helpful to comply with this request.
Page 2 of 3
337516_5
337516_5
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.
Page 3 of 3
337516_5
337516_5
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.
I (check one) DO or DO NOT want the final letter sent by Certified Mail, Return Receipt
Requested (CMRRR). I understand that there is a $10 fee for a CMRRR letter and if I request
one, I have enclosed my check for $10.00 payable to Framme Law Firm, PC or have contacted
the firm to make payment by credit card.
Please make your check payable to “Framme Law Firm, PC” and mail it to
Framme Law Firm, PC, 6800 Paragon Place, Suite 233, Richmond, VA 23230 or call our 800
number to pay by credit card over the phone.
8. 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. 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.
( )
Login to HandyPDF
Tips: Editig or filling the file you need via PC is much more easier!
By logging in, you indicate that you have read and agree our Terms and Privacy Policy.