Litigation Intake Form

Name

Please enter your name.

Street Address

Please enter your street address.

City

Please enter the name of your city.

State

Please choose your state of residence.

Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyomingZIP Code

Please enter a valid ZIP code. You may use 0-9, spaces and the ( ) – + characters.

E-mail Address

Please enter a valid e-mail address.

Home Phone Number

Please enter a valid home phone number. You may use 0-9, spaces and the ( ) – + characters.

Business Phone Number

Please enter a valid business phone number. You may use 0-9, spaces and the ( ) – + characters.

Mobile Phone Number

Please enter a valid mobile phone number. You may use 0-9, spaces and the ( ) – + characters.

Fax Number

Please enter a valid fax number. You may use 0-9, spaces and the ( ) – + characters.

If you are known by other names, please list the other names you have used.

Please list any other names you have used.

What is your marital status?

Please indicate your marital status.

Select your marital statusSingleMarriedDivorcedSeparatedWidowed

If this matter involves a business you own or run, please enter the business’s name, address and phone number.

Please enter the business’s name, address and phone number.

If a business is involved, how is the business organized (if known)?

Please indicate how the business is organized.

Select an organizationSole ProprietorshipPartnershipLimited Liability Company or PartnershipProfessional CorporationS CorporationC Corporation/OtherOther

If you are currently employed, please enter your job title and your employer’s name and address.

Please enter your job title and your employer’s name and address.

If you are being sued, please enter the name(s) of the party or parties suing you.

Please enter the name(s) of the party or parties suing you.

If you are being sued, please enter the name, address and phone number of the attorney for all parties suing you.

Please enter the name, address and phone number of the attorney for all parties suing you.

If you are being sued, please enter the name and location of the court handling your case.

Please enter the name and location of the court handling your case.

If you are being sued, please enter the date you were served with court papers.

Please enter the date you were served with court papers.

What area of law does your situation involve?

Please indicate what area of law your situation involves.

Select an area of lawAdministrative LawAdmiralty / Maritime LawAdoptionAgriculture LawAlternative Dispute ResolutionAnimal BitesAntitrust & Trade RegulationAviationAviation & Mass Transit Accid.Banking / Finance LawBankruptcy LawBusiness & Commercial LawBusiness OrganizationsChild SupportCivil RightsConstruction LawConsumer ProtectionContractsCriminal LawCriminal Law / FederalCustody / VisitationDiscriminationDivorceDUI / DWIEducation LawElder LawEmployment Law / EmployeeEmployment Law / EmployerEnergy LawEnvironmental LawEstate PlanningEthics/Professional Resp.GeneralFranchisingGovernment Agencies/ProgramsGovt. ContractsHealth & Health Care LawImmigration/NaturalizationInsurance LawIntellectual Property LawInternational LawInternet/CyberspaceLabor LawLandlord / TenantLegal MalpracticeLitigation / AppealsMedical Malpractice LawMilitary LawMotor Vehicle AccidentsNursing HomePatentPersonal InjuryPersonal Injury/DefensePremises LiabilityProbate Estate AdministrationProducts Liability LawProfessional Malpractice LawReal Estate LawScience/Technology LawSecurities LawSexual HarassmentSocial Security/DisabilityState/Local/Municipal LawTaxation LawToxic SubstancesTrademarksTraffic ViolationsTransportation LawTrustsWillsWorkers’ Compensation LawWrongful DeathPlease briefly describe your situation, including any relevant dates.

Please briefly describe your situation, including any relevant dates.

If any other people are involved, please enter their names, addresses (if known), and their relationship to you, if any.

Please enter their names, addresses (if known), and their relationship to you, if any.

If you have related documents, please list them and any corresponding dates.

Please list the documents in your possession and any corresponding dates.

If there are other helpful documents that you don’t have access to, please list them and any corresponding dates and locations.

Please list the documents you don’t have access to and any corresponding dates and locations.

Describe how this situation has affected you.

Please describe how this situation has affected you.

How would you like this issue resolved? What’s your preferred outcome?

Please describe how you would like this issue to be resolved or your preferred outcome.

If other attorneys have worked on this matter, please provide their names, addresses and a brief description of their involvement.

Please provide the names, addresses and a brief description of the other attorneys’ involvement.

Describe any special concerns.

Please describe any special concerns.

How did you hear about this Web site?

How did you hear about this Web site? Please choose one.

Select oneTelevision AdRadio AdNewspaper AdBillboardsReferred by a FriendSearch EngineOther

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

Please verify that you have read the disclaimer.

I have read the disclaimer.