LAWSUIT ON MULTIPLE PERIL INSURANCE POLICY
______Yes, I would like to participate in the lawsuit involving the breach of contract claim against the United States and other parties relating to my Multiple Peril Insurance Policy. I understand the Law Firm of Boyce & Isley, PLLC, will file a lawsuit to recover the difference in the expected insurance coverage (31¢ per pound) verses the 17.75¢ per pound rate of insurance. I understand that I am responsible for $1.00 per acre planted and insured peanuts and that the rest of the fee will be handled on a contingency fee basis. I understand no additional funds will be needed from me and that the attorneys will only collect in the event we win the lawsuit. I further understand that a copy of the attorney fee agreement will be mailed to me after I send in this form.
NAME: _____________________________, _____________________________ _______________
(LAST) (FIRST) (M.)
NAME OF FARM (If Applicable): _________________________________________________________
MAILING ADDRESS: _______________________________________________________________
STREET/POST OFFICE BOX
____________________, ______________, ________________ __________
CITY COUNTY STATE ZIP
TELEPHONE NOS. ______________________________________ (HOME)
______________________________________ (WORK)
______________________________________ (CELL)
______________________________________ (FAX)
___________________________________________________________________________________________
TOTAL ACRES PLANTED AND INSURED (PEANUTS ONLY) FOR CROP YEAR 2002: ____ ACRES
x $1.00/ACRE
CHECK TOTAL: $_________
MAKE CHECK PAYABLE TO AND MAIL TO:
BOYCE & ISLEY, PLLC
R. DANIEL BOYCE
ATTORNEY AT LAW
BOYCE & ISLEY, PLLC
POST OFFICE BOX 1990
RALEIGH, NC 27602-1990
ATTN: PEANUT CASE
