New Customer Registration Form

Lawyer Referral Service Application
Firm Name *
Firm Name
Full Name*

First NameLast Name
Firm Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Date Admitted to  NJ Bar:

MonthDayYear
Date
Admissions to  Other State Bars:
Lawyer Referral Service Fee: $175.00
* Please note that the $175.00 Lawyer Referral Service Fee
is in addition to the regular ACBA Membership dues.
Also note that all fees must be paid before an attorney
can be placed on the Lawyer Referral Panel.
$50.00 - Bankruptcy$50.00 - Collections$50.00 - Criminal Law$50.00 - DYFS$50.00 - Employment Law$50.00 - Immigration & Naturalization$50.00 - Legal Malpractice$50.00 - Municipal Law$50.00 - Personal Injury$50.00 - Social Security$50.00 - Wills, Trust & Estates$50.00 - Civil/general civil, business, & commercial disputes$50.00 - Consumer Law$50.00 - Disability Appeals$50.00 - Elder Law$50.00 - Family Law$50.00 - Landlord/ Tenant Issues$50.00 - Medical Malpractice$50.00 - Patent, Trademark & Copyright$50.00 - Real Estate / Foreclosure$50.00 - Tax Appeals$50.00 - Workers Compensation
Upon submission an invoice will be emailed to you.
Payment Preference

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Lawyer Referral Service Application