Prospective Client Information Form

The purpose of this form is to gather preliminary information from prospective clients for the purpose of running a thorough internal conflicts check, and preparing for a possible new client sign-up process.  Do not submit confidential information about your matter.  Submission of this form alone does not create an attorney-client relationship, and I will not take any action on your behalf, until we have established an attorney-client relationship through a separate signed written engagement agreement (not this form).
Primary Contact (organizer - if client is not yet formed) *
Primary Contact (organizer - if client is not yet formed)
Primary Contact Phone *
Primary Contact Phone
Secondary Contact (if any)
Secondary Contact (if any)
Secondary Contact Phone
Secondary Contact Phone
Primary Address *
Primary Address
Billing Address (if different)
Billing Address (if different)
http://
The purpose of this form is to gather public information about my prospective clients for the purpose of running a thorough internal conflicts check, and preparing for a possible new client sign-up process.  Do not submit confidential information.  Submission of this form alone does not create an attorney-client relationship, and I will not take any action on your behalf, until we have established an attorney-client relationship through a signed written engagement agreement.

 

The Law Offices of Shiloh A. Coleman, PLLC
Copyright 2017