Solicitor Firm Application

Please fill in the following form and ensure to read the terms and conditions.

SOLICITOR FIRM APPLICATION

Name of Firm

Do you have a website?

If yes, please state name

Solicitor Contact Information

Title

First Name

Mid Initials

Surname

Business Address

Town/City

County

Business Post Code

Reception Number

Fax Number

Direct Dial

Direct Fax Number

Email Address

Password

Confirm Password

Which area do you cover for personal injury?

	RTA		Trip/Slip
	CICA		Work Accidents
	Medical Negligence		Dental Negligence
	Clinical Negligence		Industrial Accidents

If others please state

Any other additional information

Billing and Business address is the same.

BILLING ADDRESS

Bill To:

Business Address

Town/City

County

Business Post Code

Reception Number

Fax Number

Direct Dial

Direct Fax Number

Have you read our basic terms and conditions?

*Your application will be declined automatically if you do NOT abide by our basic terms and conditions.

Why Choose 100% Compensation?

FREE Service	FREE Assessment	FREE Advice	FREE Phone
NO Interest	NO Loans	NO Jargon	NO Catches
NO Costs	NO Hassle	NO Deductions	100% Compensation

100% Satisfaction Guarantee - We do NOT have sales people. You will speak directly with accident solicitors (No middlemen), and gain 100% Compensation! If you are not happy at anytime during your claim, we will transfer to a firm of your choice – FREE of charge!

NO Salespeople

NO Pressure

60 Second Claim Form

2 Minute Claim Form