Client Case Evaluation Form
This form helps us to gain a better understanding of your case and our ability to assist you effectively. However, failure to complete this form accurately and in full will prevent a response.
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First Name
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Last Name
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Address 1
Address 2
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City
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State
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Zip
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Phone
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Email Address
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Additional Offers:
Do you wish to receive service offers or updates via email?
Are you interested in helping others who you know are similarly situated?
Case Information
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Case Number
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Court Location/Name
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Plaintiff's Name
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Date Compaint Was Filed
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Do You Have An Attorney
Upload a copy of the Complaint
(Must be less than 5MB)
About You
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Your gender
Male
Female
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Your marital Status
Married
Single
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Year of Birth
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Including yourself, what is the total number of people living in your household?
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Exactly how much money a month can you dedicate to the payment of litigation fees?
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For the residence in this case, is it:
Residential
Investment
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Which best describes your family income?
less than $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
over $100,000
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Education:
High School
Vocational Degree
Associates Degree
Bachelors Degree
Masters Degree
Doctoral Degree
Post-Doctoral Studies
Professional Certification
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I use these credit cards:
American Express
Discover
Debit Cards
Visa
MasterCard
Gas/Retail
Do not have credit cards
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Please enter an additional comments:
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