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LRS Online Request Form

Before filling out the form below, please note:

We will make up to three referrals per case, one at a time.
We do not provide lists.
We do not make referrals to free attorneys.
The LRS attorneys may charge $25 for the first half-hour of the consultation.
You should discuss legal fees at the consultation and obtain a written fee agreement if you hire the attorney.
We do not make referrals to "experts" or "specialists." The members of the LRS are competent, experienced and trained to handle the area of law you request. You should ask about their level of experience.
If the first referral does not work out, feel free to contact us again for another name.
We will require you to provide us with some basic information. This is for our files only. We need your name so we can let the attorney know to expect your call. We need your address so we may send you a survey asking you to rate the quality of our service. You will not receive any other mailings from us and your information is not given to any other organizations.

*First Name:

*Last Name:

*E-mail address:

*Address:

Address (continued):

*City:

*State:

*Zip:

Type of attorney needed:

Please briefly describe the type of legal help you need.

Type of help needed:

What city/town in Massachusetts would you prefer the attorney be located in?

Attorney location:

If your income falls within our financial guidelines you may be eligible for a reduced fee referral. (Please note if income information is not provided we will be unable to verify your possible eligibility for a reduced fee referral.)

*Gross weekly income before taxes:

How many people do you support with that income?

*Income supports:

How did you hear about the MBA Lawyer referral-service?

Heard from:

May we send you a survey in the mail asking you to rate the quality of our referral-services?

Receive survey:

Please fill in the following fields if you are not the client

Your name:

Your e-mail:

Relationship to Client:

Reason Client cannot contact the LRS him/herself:

Please add 1 and 5 and type the answer here: