Fillable Printable Template Authorization Letter

Template Authorization Letter

General Authorization Letter

Dear LegalShield Member:

You asked this office to senda letter onyour behalf in the legal matter indicated on the next page.

Before we will send the letter, we need the following additional information from you and your

signed authorization that the letter may be sent:

1.Ifyour claim is for money, you certify to the best of your knowledge and belief the

person/business owes you the amount you are demanding herein;

2.You are advising us that you do not already have anattorney representingyou in this

matter;

3.You did not receive any written or oralnotice from the opposing party/business nor from

any attorney indicating the opposing party filed for bankruptcy protection;

4.You are not aware of anytype ofprotection order or injunction which prohibits or

otherwise restricts you from directly or indirectly

(A)Contacting the other party OR

(B)Prohibits the other party from contacting or responding to you;

5.You already made a demand for payment from the opposing party and such demand was

unsuccessful (if you are claimingmoney owed toyou oryour businessas a result ofa

business/commercial transaction with the person, and the person is an individual, not

another business) and you are not aware the opposingparty is represented by an attorney

for this matter.

Please Note: If you would like your letter sent via Certified Mail - Return Receipt Requested,

please remit $15.00 for postage and handling fee. (If you intend to pursue your claim in

Small Claims Court, thensending the letter by Certified Mail - Return Receipt Requested,

is, in our opinion, necessary.)

Please returnformto:

Dempsey, Roberts & Smith, Ltd.

1130 Wigwam ParkwayFax: (702) 388-2519

Henderson, Nevada 89074E-mail: nvdocs@drsltd.com (all lowercase)

Rev.08/24/12

*** BEFORE WE WILL SEND A LETTER ***

EACHITEMMUSTBECOMPLETELY FILLEDIN ANDTHISFORMSIGNED

NAME: INTAKE #:

ADDRESS:

MEMBERSHIP #: PHONE #: FAX:

E-MAIL:

Please issue a letter to the below named individual or business based upon the information provided below:

1.Full Name ofOpposingParty:

2.OpposingParty'sCompleteAddressincludingzipcode(ifabusiness,werequirefullnameifOpposing

Party Representative and/or Owner):

3.A brief & legible description of the facts that giverisetothe need for this letter (please give dates and

details oftheoccurrence, use separate sheet ofpaper ifnecessary):

4. Thedemandthatyouwishfor ustomakeontheOpposingParty(NOTE: ifthisisademandfor

damages, please specify the TOTAL amount andhow it was computed; principal, interest, repairs, costs

ofcompletion, etc.):

Signature: Date:

This GAL does not apply to enforcing lien rights, since specific time frames and procedures may apply. If specific lien rights

you wantto enforce, you must contact this office to discuss how to protect and enforce your lien, or you may lose your rights.

Please attach photocopies of any supporting documents up to 10 pages, i.e., contract, prior letters, invoices.

(DO NOT SEND YOUR ORIGINALS.)

G YES G NOPleasesendDRAFTformyreview before mailing final.

Please select your preference:G FaxG U.S. MailG E-mail

Rev.08/24/12