Your Info

First Name: *

Last Name: *

Firm Name: *

Email: *

Email 2 (optional):

Email 3 (optional):

Claimant

First name: *

Last Name: *

Phone: *

Email:

Case Type *

Case ID: * 🛈

Replacement Information

Please tell us the reason why you'd like to submit a replacement request for this case. If this is a dual representation issue, please also include the firm name the claimant had prior representation with. *

If filing for a replacement due to dual representation with your firm, please attach a copy of the redacted retainer the claimant signed.

Please be informed that upon acceptance of a replacement request our office will automatically generate a close letter and forward it to the claimant if our firm is listed on the retainer agreement. In all other instances, it is the requesting firms responsibility to provide the claimant and all offices a close letter that includes all associated firms.