MCBA LRS Referral Form

Enter Your Information

Please give us your contact information:

First Name	*
Last Name	*
Mailing Address	*
Address
City	*
State	*
Zip	*
Main Phone	* Ext.
Alternate Phone	Ext.
Email	*


Please specify the type of lawyer that you need:

I need an attorney who specializes in:


I need an attorney who practices in New York and in:


I need an attorney who speaks:


I prefer the following area of town:


Please describe your legal issue:


There is a $40.00 referral fee (waived for personal injury, all negligence, workers' compensation and Social Security Disability matters) which includes the first half-hour consultation with the lawyer. Should you choose to hire the lawyer after the initial consultation, fees will be arranged between you and that lawyer.