* Your Name

* Company Name

* Birthday (day/month)

* Title/Position

* Address

Address 2

* City

* State

* Zip

* Can we send confidential attorney-client information to this address?

If so, do we need to take any special precautions such as
“To the Attention of __________”, hand delivery only, etc.?

Phone

Mobile

Fax

* Email

* Alternate contact person name, title and number

* Preferred methods of contact (time, number, email, in person, etc.)

* Affected parties in the matter (to determine whether the firm has any conflicts that would prevent it from handling the matter)

* How did you learn about the firm? Who referred you?

* Have you ever worked with an attorney on any matter before?

If yes, please describe. (The description gives us an idea of how familiar you are with routine law firm procedures and how law firms typically operate).

* Please provide a brief description of your legal needs or issues:

* How would you like to see this matter resolved?

* On a scale of one to ten, with ten being the highest, how important is this issue to you?
Select
1
2
3
4
5
6
7
8
9
10

* Have you sought legal advice from another attorney on this matter?

If so, whom?

* What actions have you taken to date to address this matter?