Please complete and submit the form below.  Please contact Jim at, or at (800) 342-9856 with any questions.

If you would prefer to print, complete and email or fax this form to our office, CLICK HERE to complete the PDF and email to or fax to (800) 354-3381.  You may also upload the completed PDF below.

PLEASE NOTE: If you are requesting this service, you must provide a Certificate of Good Standing from the Appellate Division in which you were admitted.  The original copy of the certificate must then be mailed to Gerald Weinberg PC at 90 State Street, Suite 815, Albany, NY 12207.