Full Legal Name *

First Name

Last Name

Phone Number *

(###)

###

####

Fax Number

(###)

###

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Do you prefer to speak with a lawyer in person or by telephone?

Telephone

In Person

First Available

Please contact me to schedule the consultation by:

Telephone

Email

Do you agree? *

Please read carefully, and check “yes” if you agree before submitting this form. I understand that a telephone consultation is not free unless I meet the criteria above. I further understand that information on this form is confidential, but that submission of this form does not create an attorney-client relationship. The Firm requires payment of the consultation fee prior to your telephonic appointment, and prior to or at your in-person consultation. Payment can be by check, money order or credit card (Visa, MasterCard and Discover) or wired funds consultations. In addition to those forms of payment, we also accept cash for in-person consultations.

Yes

No