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Litigation Intake Form

Please provide the following information to help us prepare for your case.

Salutation

Name

First Name

Last Name

Company

Street Address

City

State/Province

Zip/Postal Code

Home Number

Work Number

Cell Number

Primary Phone Number

Home

Work

Cell

Do you or your business have a webpage?

(If yes, put the URL below)

Are you on Facebook?

Yes

Do your or your business have a Twitter Account?

(If yes, please list your and your company's Twitter handle(s))

How did you hear about us?

What are you interested in learning more about?

General legal representation for your business

Business consulting for your business

Legal representation in a pending dispute

Please describe your issue in as much detail as possible.

PLEASE READ CAREFULLY BEFORE SUBMITTING

Following your initial interview, if you agree to hire us, and we agree to represent you, we will send to you a retainer agreement. The retainer agreement will set forth the terms and conditions of our representation. If we are willing to represent you and you decide not to sign the retainer agreement, you are strongly urged to schedule a second appointment with the Attorney at the earliest possible time or to immediately consult with other legal counsel to protect your rights. NOTICE: This office does not represent you with regard to the matters set forth by you in this information sheet or discussed during your consultation, unless and until, both you and the Attorney execute a written retainer agreement. If we do not agree to represent you, this includes not representing you with regard to the matter set forth by you on this information sheet, or any other matters you may discuss with the Attorney during your consultation. If your legal problem(s) involve a potential lawsuit, it is important that you realize a lawsuit must be pled within a certain period of time called a Statute of Limitations or within the applicable rules of procedure. Therefore, we strongly urge you to immediately consult with another attorney to protect your rights. Our decision not to represent you should not be taken by you as an expression regarding the merits of your case. By submitting this intake form, you acknowledge that you have read this disclaimer, answered these questions truthfully, and understand that this does not mean you have hired an attorney