1629 K Street , N.W Suite 300 Washington, D.C 20006
(202) 600-7670
1629 K Street N.W. Suite 300
Washington, DC 20006
ph: 202-600-7670
fax: 202-800-7484
orlando
DISCLAIMER:
SUBMITTING YOUR INFORMATION ON THIS FORM DOES NOT CREATE AN ATTORNEY/CLIENT RELATIONSHIP. WHILE WE HAVE A DUTY TO REFRAIN FROM DISCLOSING CONFIDENTIAL INFORMATION THAT YOU PROVIDE, WE HAVE NO OBLIGATION TO REPRESENT YOU OR ACT IN FURTHERANCE OF YOUR INTERESTS UNLESS AND UNTIL WE ENTER INTO A WRITTEN AGREEMENT WITH YOU OUTLINING THE TERMS OF REPRESENTATION AND ALL FEES ARE PAID.
CLIENT INTAKE SHEET
Thank you for completing the following form. We realize the information asked for is confidential, but in order for our firm to give you the best recommendation for your particular situation, please complete the form fully and accurately. If you do not know exact information, please complete the blank with your best guess.
HOW DID YOU HEAR ABOUT US? CHECK ONE PLEASE
TV | Phone Book | Internet | Sign | Referral (Who?)
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Client Information
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FIRST NAME |
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MIDDLE NAME |
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LAST NAME |
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SOCIAL SECURITY NUMBER |
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EMAIL ADDRESS |
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ADDRESS
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Street Number |
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City, State, Zip County |
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PHONE NUMBERS YOU (CLIENT) OPPOSING PARTY
HOME PHONE |
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WORK PHONE |
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CELL PHONE |
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CURRENT CASE STATUS:
DO YOU HAVE A SIGNED LEASE? YES______ NO_______
IS THE RENT SUBSIDIZED? _____________________
IF RENT IS SUBSIDIZED (NAME OF AGENCY) ___________________________
HOW LONG IS LEASE? _____________________
LAST MONTH RENT WAS PAID _____________________
AMOUNT OF RENT _____________________
Copyright 2012 Law Offices of Leslie O. Perry. All rights reserved.
1629 K Street N.W. Suite 300
Washington, DC 20006
ph: 202-600-7670
fax: 202-800-7484
orlando