Attorney Referral Request Form

There is a $25.00 Application Fee that must be paid before you will receive your Attorney Referral. You can pay by credit card, money order, or personal check (check must clear before application will be processed). Make money order/check payable to "Florida Fathers United".

Name: Address:

City: State: Zip Code:


Driver's License Number:

Place of Employment:

Home Telephone (with Area Code):

Best Time to Reach Me at Home Is:

Type of Case:

Child Support Reduction Visitation Enforcement

Custody Fight Behind in Child Support

I am:

Custodial Parent Non-Custodial Parent

Please provide a brief summary of your case:

By submitting this request, I agreed that Florida Fathers United, and Florida Fathers United Attorney Referral Service will not be held responsible for the outcome of any hearings, decisions, or actions taken by the court. Furthermore, I understand that any balances due to the Referral Attorney(s) are not the responsibilty of Florida Fathers United, or Florida Fathers United Attorney Referral Service, and that no promises have been made to me of any guaranteed success in the courtroom. Also, any official complaints that I wish to make against a Referral Attorney must be made through the proper channels with the Florida Bar.

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