Prospective Client Questionnaire

BIOGRAPHICAL INFORMATION

Company Name

(If Company is to be Client)

Full Legal Name

First Middle (not initial) Last & Suffix Maiden

Date of Birth

Citizenship: United States

Yes
No

Mailing Address

Street Address Address Line 2 City State ZIP Code

Street Address

Street Address Address Line 2 City State ZIP Code

Phone (Home)

Phone (Business)

Phone (Cell)

Fax Number

Email Address

Spouse's Full Legal Name

First Middle (not initial) Last & Suffix Maiden

Date of Birth

Citizenship: United States

Yes
No

Mailing Address

Street Address Address Line 2 City State ZIP Code

Phone (Home)

Phone (Business)

Phone (Cell)

Fax Number

Email Address

INFORMATION REGARDING THE MATTER

Select all that apply

Civil Litigation
Corporate Law
Contracts
Divorce & Family Law
Estates/Wills/Trusts
Appellate

Briefly state the nature of the problem or matter

Name(s) of Opposing or Other Involved Parties

Mailing Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Email Address

Name of Attorney(s) Representing the Above Parties

Mailing Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Email Address

PRIOR REPRESENTATION & REFERRAL INFORMATION

Have we represented you before?

Yes
No

Which attorney represented you?

How did you discover us?

Family/Friend Referral
Professional Referral
Advertisement
Internet Search
Social Media
Civic Club
Other

Family/Friend Referral (Please provide who and/or where)

Professional Referral (Please provide who and/or where)

Advertisement (Please provide who and/or where)

Internet Search (Please provide who and/or where)

Social Media (Please provide who and/or where)

Civic Club (Please provide who and/or where)

Other (Please provide who and/or where)

I HAVE REVIEWED THE INFORMATION CONTAINED HEREIN AND BELIEVE IT TO BE ACCURATE, AND I UNDERSTAND THAT NO LEGAL RELATIONSHIP WILL BE CREATED BY MY VISIT UNLESS AND UNTIL THIS OFFICE AGREES TO REPRESENT ME IN THE ABOVE MATTER.

PROSPECTIVE CLIENT SIGNATURE