ORDER FORM                     

Thank you for the assignment. We will begin immediately and submit a Billing & Service Agreement per your order. Payment is due upon receipt of agreement. For convenience, we accept VISA, MASTERCARD, AMEX and DISCOVER.
Please print this form, make any necessary copies and FAX TO: 800-206-6096

Date:___________________________________

Your Name:____________________________________Your Reference:_____________________
Law Firm/Company Name:__________________________________________________________
Address:_________________________________________________Suite:___________________
City:_____________________________________State:___________Zip:____________________
Telephone:_______________________________ Fax:____________________________________
Email address: ___________________________________________________________________
Type of Assignment:__________________________________________Fee:_________________
This assignment is/concerns a ___ pre-litigation matter ___ post-judgment matter ___ in litigation now
Would you like to receive a telephone call before we initiate this assignment? ____yes ____not necessary
Repeat Client?_______ If not, please tell us how you were referred to PAL:______________________

                                                                            Subject Information
                                                   (Please provide as much subject information as possible)

Subject Name: ___________________________________________________________________
Aka's: _________________________________________________________________________
Spouse Name/Aka's: ____________________________________Include spouse? ___ Yes ___ No
Home Address ___ Current ___ Previous (as of: ______________) _____________________________________________________
_____________________________________________________
Telephone: ________________________________
Social Security Number: ___________________________Spouse SSN: _____________________
Date of birth: ____________________________________Spouse DOB: _____________________
Drivers license No.: _______________________________Spouse DL#: ______________________


Business Name: _________________________________________________________________
Business address: ___ Current ___ Previous (as of: ____________) _____________________________________________________
_____________________________________________________
Telephone: _______________________Fax:________________
FEIN: ________________________________________
Type of business: ___ Corporation ___ Partnership ___ dba ___ unknown

Relatives/Friends/Associates/Principals/Known Assets/Physical Description/Notes: ________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________