ASSIGNMENT OF INTEREST AND

CONTRACT OF EMPLOYMENT FOR ACCIDENT VICTIMS

HALLACK LAW OFFICE (herein referred to as Attorney) and ______(herein referred to as Client, whether one or more) enter into the following assignment of interest and contract of employment:

SCOPE OF REPRESENTATION: Client employs Attorney to represent him/her/them for ______which occurred on ______, 201__.

FEE:As consideration for legal services rendered and to be rendered by the Attorney in carrying out the purpose hereof, Client agrees to pay the Attorney one-fourth (25%) of all amounts recovered before suit is filed, whereupon the fee increases to 35%, and should the case be brought to trial, the fee will thereupon increase to 40%. Client assigns, and Attorney accepts and acquires as his fee, a proportionate interest in the subject matter of any claim, action, or suit instituted or asserted under the provisions of this agreement. Any award for attorney's fees shall belong to the attorney separate from any other fee.

COSTS AND EXPENSES: Client shall be responsible for all costs expended on his behalf in the presentation of Client'sclaim, however, Attorney agrees to advance such costs during the pendency of the claim or litigation. These shall include filing fees, courier fees, witness fees, travel, parking, long distance telephone calls, facsimile use, postage, copying charges, computer aided research charges, sheriff's and constable's fees, expenses of depositions, investigative expenses, and other incidental expenses. Attorney agrees to obtain Client's prior approval before incurring any single expense in excess of $500.00. Costs will be deducted out of the Client's portion of any recovery.

CONSENT TO SETTLEMENT: Neither the attorney nor the client shall have the authority to settle the client’s claim without the consent of the other.

Executed on this ___ day of ______, 201___ , after due reading of the whole.

CLIENT(S)

HALLACK LAW OFFICE______

______

By: ______

Robert W. Hallack