Contact Information
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Last Name
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Firm Name
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Address
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Office Phone Number
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Cell Phone Number
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I Agree to the
Coverage Attorney Agreement
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Practice Information
What year did you graduate from law school?
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How many years have you been practicing law? (3 years minimum required)
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Practice Area 1
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Practice Area 2
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Practice Area 4
Do you handle insurance defense matters?
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Do you represent Plaintiff(s) in personal injury/tort cases?
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Do you have any active cases representing a Plaintiff(s) in a personal injury/tort case?
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How recently have you represented a Plaintiff(s) in a personal injury/tort case?
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Within the last year
2-3 Years
4+ Years
Please let us know who you represent
In foreclosure cases, I represent or appear at hearings on behalf of:
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Banks/Creditors ONLY
Debtors/Homeowners or Plaintiffs and Defendants
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Credential and Other Information
Please upload a copy of your resume/profile/bio
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State admitted to practice in
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Bar Number (if none, please put "N/A")
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Please upload a copy of your insurance declaration page
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Insurance Amount
Insurance Expiration Date
I prefer to be paid as
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SSN (AAA-BB-CCCC)
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Federal Employee ID Number or Tax ID Number
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Date of Birth
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Month
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Day
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Year
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How did you hear about us?
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Details
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Which counties do you cover?
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Which additional states are you admitted to and eligible to practice in?
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Bar Number
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Bar Number
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Bar Number
Have you ever covered hearings before?
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Yes
For whom:
What type of matters?
Ever you ever been the subject of a bar complaint?
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Yes
Details
I agree that I alone will appear for cases assigned to me and I will not have any other attorney
from my firm or otherwise appear for any case(s) assigned to me.
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I agree
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Upload a picture of yourself for your profile
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Are there other attorneys in your area, or elsewhere, that you would recommend and refer to MMC?
Attorney Name
Phone Number
Email
Attorney Name
Phone Number
Email
Attorney Name
Phone Number
Email