Criminal Defense Information
CLIENT INFORMATION
Full Name (*)
Please provide the full name of the person who will be the client
Email address (*)
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Drivers License No. & State
Status of Drivers License
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Date of Birth & Current Age
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US Citizen?
Please check whether you are a citizen or the United States
Best Time to Contact & Where
Please advise of when, where and how to contact you
Emergency Contact Name, Phone & Relationship
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Residence Information
Residence Street Address
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City/State/ZIP Code
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Home Phone Number
Cell Phone Number
Home Email Address
Please provide a valid email address to contact you
Employment Information
Employer Name
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Work Phone Number
Work Email Address
Job Title & Description
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Length of Employment
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Annual Salary or Hourly Wage
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Legal Assistance Information
Nature of Legal Assistance Needed (*)
Please explain how we may help and the legal services you need
   
COURT PROCEEDINGS
Is a Case Pending?
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Nature of Proceedings
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Your Status in the Case
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Name of Court
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Case Number
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Is a Court Hearing Scheduled?
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When is the Hearing Scheduled?
(date & time)
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What is the Hearing About?
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Prior Arrests, Charges, Convictions, Traffic Offenses or Other Legal Problems
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Name of Your Current or Former Attorney
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Referred By?