Form to Request Sample Language for Agreement

Requesting Attorney Data

Are we being jointly retained in this matter (we will automatically copy your adversary on all correspondence and the completed documents).
Yes      No

Do you represent the Husband or Wife?
Husband      Wife

Did we prepare a pension evaluation report in this matter?
Yes     No

Which party has the benefit?
Husband     Wife

Full name of the party who has the benefit:

Name of Plan(s) to be divided in the Agreement. (If you are not clear on the exact name of the Plan provide the name of the employer for the party who has the benefit and advise if the Plan is a "Pension Plan" or a "401(k) Plan", etc.):

Delineate in lay language what you are trying to obtain for your client from each Plan(s) listed above, i.e. percentage or dollar amount to be awarded from each Plan, survivor or death benefits to be assigned, etc.

WE WILL REVIEW THE ANTICIPATED SETTLEMENT THAT YOU ENTER BELOW. IF WE ARE RETAINED SOLELY BY YOUR OFFICE AND WE BELIEVE THE SETTLEMENT DOES NOT ADVANTAGE YOUR CLIENT WE WILL NOTIFY YOU ACCORDINGLY BEFORE WE DRAFT THE LANGUAGE. IF WE ARE JOINTLY RETAINED WE WILL ASSUME THAT THE PARTIES HAVE NEGOTIATED THE DIVISION OF ASSETS YOU HAVE DELINEATED AND WILL PREPARE THE LANGUAGE ACCORDINGLY UNLESS YOU CHECK THE BOX BELOW.

I WANT YOU TO CONTACT ME IF MY CLIENT HAS BEEN DISADVANTAGED BY MY SUGGESTED DIVISION OF ASSETS.
Yes     No

IF WE NOTE ANY LANGUAGE THAT CANNOT BE IMPLEMENTED IN A QUALIFIED DOMESTIC RELATIONS ORDER WE WILL ALERT YOU PRIOR TO DRAFTING THE LANGUAGE.

DELINEATE BELOW THE AMOUNT TO BE ASSIGNED TO THE NON-PROPERTIED SPOUSE FROM EACH ENTITLEMENT:

Credit Card & Billing Information

The below credit card will be charged $250.00 to provide language for the Property Settlement Agreement which will cover up to two qualified benefits. If language is required for more than two benefits, the additional fees are as delineated in our Fee Schedule ($400.00 for up to 4 benefits; $550.00 for up to 6 benefits. If the language is to cover Non-Qualified benefits the fee is based on the complexity of the task at a minimum rate of $200.00 per benefit. (We will advise you of the fee for the Non-Qualified benefits once we review your anticipated award to the non-propertied spouse.) If you have any questions regarding the appropriate amount to be charged you may contact a technician at 1-877-443-4867 and we will assist you. The completed Order(s) will be sent from our office by regular mail.

Before submitting this data to us please double check all of the information you have entered to make sure it is correct.