United States Bankruptcy Court _________________District of Arkansas _____________________Division RE:___________________________________ Case No:______________________ APPLICATION FOR ATTORNEY FEE 1. Comes ____________________________, attorney for the debtor(s), and states that she/he has or will perform the following legal services for the debtor(s) in the prosecution of this case, to wit: preliminary meetings with and counseling of debtor(s); preparation and filing of petition, schedules, plan, and any other required statements or support documentation; attendance of 341 (a) meeting of creditors; and any and all other services reasonably necessary for obtaining initial confirmation of the plan, including, only by way of example, the handling of confirmation hearings, negotiations with creditors and other parties in interest, motions to dismiss, motions for relief from stay, and pre-confirmation modifications to the plan. 2. Petitioner has reached the following arrangement with the debtor that the Court allow a total fee of $_________ for said services rendered to date and the routine duties required for the completion of the plan and that the fee be distributed as follows: TOTAL FEE COPYING CHARGE FEE LESS FEE ALREADY RECEIVED (do not include filing fee) TOTAL ATTORNEY FEE TO BE PAID BY TRUSTEE $______________ $______________ $______________ $______________ 3. Petitioner further states that no understanding nor agreement has been made directly or indirectly for the division of fees between petitioner and debtor, or any person, firm or corporation. 4. Debtor and petitioner agree that the Trustee shall first pay administrative costs, then an initial fee to the petitioner of $600 from funds paid in by the debtor, after administrative costs have been paid, and the remaining fee at the rate of 10% of the total disbursed to creditors each month. Respectfully Submitted, APPROVED BY: ________________________________ Debtor ________________________________ Debtor ________________________________ Trustee APPROVED FEE: $ _______________ __________________________________ Attorney __________________________________ __________________________________ __________________________________ Address __________________________________ Phone Number __________________________________ United States Bankruptcy Judge American LegalNet, Inc. www.FormsWorkflow.com