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Case Caption:


Application for
Pro Hac Vice Admission




Case No.


I declare under penalty of perjury:

1.   That I seek to appear pro hac vice in order to represent
in the above-captioned matter;


2.   That I am admitted to practice law in the highest court(s) of the state(s) or country(ies) of ;


3.   That there are no disciplinary complaints filed against me for violation of the rules of those courts (if so, please explain): ;


4.   That I am not suspended or disbarred from practice for disciplinary reasons or reason of medical incapacity in any jurisdiction (if yes, please explain): ;


5.   That I am associated with Attorney , Sponsor name was not found. Please retry name to select from the dropdown list. State Bar No. , an active member of the State Bar of Wisconsin (name the member of the State Bar of Wisconsin and provide his/her Member Number);


6.   That I do not practice or hold out to practice law in the State of Wisconsin;


7.   That I acknowledge the jurisdiction of the courts of the State of Wisconsin over my professional conduct, and I agree to abide by the rules of the relevant division of the Circuit Court of the State of Wisconsin, the Wisconsin Court of Appeals, the Wisconsin Supreme Court, and the Rules of Professional Conduct for Attorneys, if I am admitted pro hac vice;


8.    That I have complied fully with SCR Rule 10.03 (4);


9.   That I am applying for admission pro hac vice for the following reasons:


I have applied for admission pro hac vice in the courts of the State of Wisconsin times previously in this calendar year.


I attach here too evidence of my payment or prior payment of the pro hac vice fee.


Signature of Attorney

Telephone Number

Name Printed

Email Address (if any)


Address of Principal Office

Address 1:

Address 2:



Zip Code:


Billing Address

First Name
Last Name
Address 2

Credit Card Information

Amount to Charge $250.00
Card Type
Card Number
Name on Card
Card Security Code