PSB Pro Bono Service/Costs Request

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Date:*

Case Information

Court Case #:

PSB Case #:

Pro Bono Attorney Name:

Attorney Phone Number:

Client Name:

Services Requested

Type of Services Requested by Client and or Attorney: (check all that apply)

Translator

Court Reporter

Process Server

Other (please fill below)

Other (Please indicate what services are being requested & circumstances)

📌 Miami-Dade County and Dade Legal Aid have negotiated discounted vendor pricing on behalf of our clients. Clients have been advised that they are responsible for all costs involving their litigation matter. In the event that a client cannot afford these services, very limited funds may be available to help cover the costs associated with their case.
🔒 Please complete this form along with a description of client circumstances for review and determination by our accounting department.
✅ Upon approval, the vendor list will be sent via email along with the accounting authorization code to order the approved services.

Reimbursement Request (if applicable)

Please attach invoice:

Max. file size: 15 MB.

Total amount for reimbursement:

Accounting Authorization Code:

Pay to the Order of:

Mailing Address:

Street Address Address Line 2 City State ZIP Code

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