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COUNSELORS & ATTORNEYS AT LAW
 
 
Call Us Today:
 
 
127 S Cool Spring St, Fayetteville, NC 28301, Located across the parking lot from the Cumberland County Courthouse
 
 
 
 
 
 

Potential Client Intake Form

 
Note: The following questions will help us to understand your legal needs. Even though completing this form does not establish an attorney/client relationship, your responses are protected by attorney/client privilege and will be held in strict confidence. The attorney/client relationship is only finalized upon verbal and/or written confirmation by the attorney and payment of retainer.

 
Name *
 
 
 
 
Nickname
 
 
 
 
Maiden Name or Alias
 
 
 
 
Mailing Address
 
 
 
 
 
 
 
 
 
 
 
Email *
 
 
 
 
Main Phone *
 
 
 
 
Other Phone
 
 
 
 
Date of Birth *
 
 
 
 
How did you hear about us? *
 
 
 
 
Gender
 
 
 
 
Race
 
 
 
 
Driver's License/ID Number
 
 
 
 
What state issued your driver's license?
 
 
 
 
Do you hold a Commercial Driver's License (CDL)?
 
 
 
 
Marital Status
 
 
 
 
Spouse's Name
 
 
 
 
Please describe in detail the nature of your legal problem?
 
 
 
Please upload any pertinent documents (i.e. citations, summons, etc.), pictures or other files.
 
 
 
 
When is your next court date?
 
 
 
 
Was there an accident involved in your case?
 
 
 
 
If so, have the property damages and/or injuries been paid?
 
 
 

If your mail is returned as undeliverable or telephone service terminated, please provide the name of someone (friend or relative) you believe will always know how to contact you.
 
Backup Contact's Name
 
 
 
 
Backup Contact's Relationship to You
 
 
 
 
Backup Contact's Phone Number
 
 
 
 
Backup Contact's Address