Lawyer Support Services of America, LLC

Helping Lawyers Serve America

Premium Lawyer Listing w/ 20 Page Website

Lawyer Name: ____________________________________________

Firm Name: ____________________________________________ (optional)

Address: ____________________________________________

City, State, Zip: ____________________________________________

Telephone Number: ________________

Fax Number: _____________________ (optional)

County: _____________________

Practice Areas: (Premium Listings include up to 5 Practice Areas)

p Adoption

p Agriculture

p Bankruptcy

p Business Law

p Criminal Defense

p Divorce

p DUI – DWI

p Elder Law

p Employment Law

p Entertainment

p Environmental

p Estate Planning

p Family Law

p General Litigation

p Immigration

p Information Technology

p Intellectual Property

p Medical Malpractice

p Personal Injury

p Real Estate

p Social Security

p Taxation

p Technology – Internet

p Traffic

p Trial

p Trusts & Estates

p Wills & Probate

p Worker’s Compensation

p Wrongful Death

Short Description: ______________________________________________________________

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(This will be the brief description or information that shows on the search page, limited to 200 characters)

Lawyer Profile: ________________________________________________________________

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Firm Profile: __________________________________________________________________

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Other Offices: _________________________________________________________________

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Office Hours: __________________________________________________________________

Memberships:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Education: ___________________________________________________________________

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Experience: __________________________________________________________________

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Email Address: ________________________________________________________________

Would you like potential clients to be able to use our secure contact form to contact you via email? p Yes p No (Potential clients will not be given your email address)

Website:______________________________________________________________________

p www.FindLawyersinMyState.com

p www.FindIllinoisLawyers.com Complimentary for first year

p www.HellsLawyer.com Complimentary for first year

p listing on above sites plus 20 Page Website $ 895.00

Domain Name: ___________________________________ (i.e. www.mydomain.com)

p I Have already registered the above domain name

p I would like LawyerSupportServices.com to register my domain name for me (Free for the first year and then $15.95 per year).

p Enclosed is a check in the amount of $ 895.00

or pay by credit card

p I wish to pay by Credit Card

First Name as it appears on your card: ____________________

Last Name as it appears on your card: _____________________

Card Type: Visa MasterCard Discover American Express

Card Number: _______________________________________

Expiration Date: ______________________________________

Card Security Code: __________ (sometimes referred to as CVV)

Card Billing

Address: ______________________________________

City: _______________ State: ______ Zip: _________

Telephone Number: _____________________

By Signing below I agree to $895.00 to be charged to my above credit card.

Authorized Signature: __________________________________

If your firm would like listings for all its lawyers, please call us for volume discounts at 815.233.6203.

By signing below, I agree to the Terms of Service. See website for Terms of Service.

_______________________________________ ______________

Signature Date

If paying by credit card, please fax to 815.235.8660

If paying by check, return to:

Lawyer Support Services of America, LLC

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Freeport, IL 61032

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