Participating Attorney Application

Participating Attorney Application – Page 2

This field is for validation purposes and should be left unchanged.

Identification

Name(required)

First Last

Gender(required)

Male

Female

Other

Date of Birth(required)

Law Firm Name(required)

Office Location(required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mailing address

My mailing address is the same as my law office address.

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email Address(required)

Website

Office Phone Number(required)

Fax Number

Additional Practice Location

Other Office Location Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How did you hear about Texas Legal?

Texas Legal

Texas State Bar

Participating Attorney

Other

Name

Other

Payment

Tax ID or SSN (No space or dashes)(required)

Select Party to Recieve Payment(required)

Attorney

Firm

Education

Law School (J.D. or equivalent):

Graduation Date

School + Other Advanced Degree(s) (L.L.M., M.D., Ph.D, etc.):School + Other Advanced Degree(s) (L.L.M., M.D., Ph.D, etc.):

Graduation Date

License

Bar Admission Date(required)

State(required)

State

Bar Number(required)

Board Certifications

Bar Admission Date

State

Bar Number

Board Certifications

Is your office accessible to disabled persons?

Yes

Is your office able to accommodate hearing-impaired clients?

Yes

Is your office able to accommodate visual-impaired clients?

Yes

Are you able to meet members at a remote location?

Yes

Are you willing to travel to represent clients?

Yes

Does your office provide after-hours appointments?

Yes

Does your office provide weekend appointments?

Yes

Would you like to participate as a paid guest speaker at Texas Legal educational events?

Yes

Are you interested in being a Legal Access Line Provider?(required)

Yes

Languages Spoken:

Hourly Rate(required)

LGBT Friendly?

Yes

Office Hours:

Example: Monday - Friday 9AM-4PM

Please submit a short bio about yourself and your practice for our members. (Maximum 1,015 Characters)

Service Area

Texas Legal has members across the Lone Star State! By updating your service area, you will be helping more Texans. Our Attorney Finder search feature allows members find attorneys in their area that fit their specific need– all with a click of a button! Don’t miss out on the opportunity to expand your practice!

South Region

Northwest Region

East Region

Panhandle Region

Central Region

West Region

Dallas/Fort Worth Region

Gulf Coast Region

Rio Grande Region

Brewster

Culberson

El Paso

Hudspeth

Jeff Davis

Presidio

TYPE OF SERVICE

Please indicate the following areas of law in which you are qualified to provide legal services

Criminal Law

Family Law

Financial Law

Chapter 7 Bankruptcy

Chapter 13 Bankruptcy

Foreclosures

Loan Agreements

Real Estate Transactions

Social Security/Disability

Tax Law

Property Tax- Primary Residence

Estate Planning/Probate

Wills/Codicils

Powers of Attorney

Probate

Trusts

Annual Accounting of Guardianship

Elder Law

Deeds

Consumer Law

Civil Action (Defense)

Consumer Protection (E.g., Breaches of Warranty, DTPA claims)

Contracts

Creditors Rights & Collections

Identity Theft

Tenant's Rights

Miscellaneous

Document Preparation/Review

Employment Law

Personal Injury

Immigration

Mediation

School Administrative Hearings

Medicaid/Medicare

Veteran's Benefits

Uploads

Professional Liability Insurance(required)

Attach a copy of your current Professional Liability Insurance-Declarations Page for coverage that is at minimum in the amount of $100,000 per occurrence and $300,000 per year aggregate.

Max. file size: 50 MB.

Direct Deposit Form(required)

You can download a copy of the form here.

Max. file size: 50 MB.

Attorney Agreement(required)

You can download a copy of the form here.

Max. file size: 50 MB.

W9(required)

You can download a copy of the form here.

Max. file size: 50 MB.

Legal Access Line Attorney Addendum(required)

You can download a copy of the form here.

Max. file size: 50 MB.

Acknowledgement

I am applying to be a Participating Attorney in the Texas Legal Protection Plan, Inc. (Texas Legal). As an inducement to Texas Legal to accept this application, I hereby

Represent and warrant that I am a licensed attorney and regularly engage in the practice of law;
Represent that I have received, read, and agree to the terms of Texas Legal’s Participating Attorney Agreement;
Attach proof of coverage not less than $100,000 per occurrence and $300,000 per year in the form of a copy of the declaration page of my professional liability insurance policy;
Attach completed IRS form W-9 indicating required payment instructions;
Attach completed Direct Deposit Enrollment Form.

Signature(required)

Date(required)

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