New Client Contact Sheet

  
Date: 11/20/2008 8:50:54 PM
GENERAL INFORMATION
HAVE YOU SPOKEN WITH ANOTHER ATTORNEY ABOUT THIS CASE? Yes: No:

Any information you send to the Bates Law Firm will be held in strict confidence.
IF SO, PLEASE GIVE THE NAME OF THE ATTORNEY
DO YOU HAVE A SIGNED RELEASE BY THAT ATTORNEY Yes: No:
WHO REFERRED YOU TO OUR OFFICE? (Individual, Yellow Pages, Lawyer Referral..)

PERSONAL INFORMATION
  Name:  
Street Address:
City:

Zip:

County:
How long have you lived in this county?
Phone Numbers:

(Home ) (Work) (Mobile)
(Pager)

Email Address:

EMERGENCY CONTACT

Who will always know where you are?

Name:

  
Relationship:
Address:
Telephone Number:

WHY HAVE YOU CONSULTED AN ATTORNEY?

Clicking the 'Send' button below does not establish an attorney client relationship. An attorney client relationship is first established when an employment contract has been signed between the attorney and the prospective client.