CLIENT INFORMATION SHEET
CLIENT INFORMATION SHEET Date:___________
INFORMATION ABOUT YOURSELF:
Name: ____________________________________________________________
Address: __________________________________________________________
City: ___________________________ State: __________ Zip Code:__________
Telephone: (H): ________________________ (W)______________ (Cell) ___________
E-Mail Address: __________________________________________________________
Date of Birth: _________________________
Social Security Number ____ - ___- ____
Employer: _______________________________________________________________
Occupation / Position: _____________________________________________________
Gross Monthly Income from All Sources: __________________________
How Long Have you Lived in Arizona? _______________
Are you in the Military? ______________ If so, for how long? ____________
Do you have a Will or Trust? ___________
Have you been through a prior divorce? ____________________________________
Referred by: _______________________________ Yellow Pages? _________________
Do you plan to change your name, and if so to what? ____________________________
INFORMATION ABOUT YOUR SPOUSE / OPPOSING PARTY:
Name: _________________________________________________
Address: __________________________________________________________
City: ___________________________ Sate: __________ Zip Code:__________
Telephone: (H): ________________________ (W)______________ (Cell) ___________
Date of Birth: _________________________
Social Security Number ____ - ___- ____
Employer: _______________________________________________________________
Occupation / Position: _____________________________________________________
Gross Monthly Income from All Sources: _________________________
How Long Have you Lived in Arizona? _______________
Who is his/her attorney? ____________________________________
Is she or he Military? ______________ If so, for how long? ____________
Has he/she been through a prior divorce? ______________________
INFORMATION ABOUT YOUR MARRIAGE ( IF APPLICABLE):
Date of Marriage: ___________________________
Place of Marriage: City ______________________ State _____________________
Is there a Pre-Nuptial Agreement? _____________
Date of Separation: __________________________
Do you have an Order of Protection against your spouse? _______________
If so, when did you get it? _________________________
INFORMATION ABOUT YOUR CHILDREN ( IF APPLICABLE):
Name Age Birthday Current Residence Name of Other Parent
Number of Children you and your spouse have in common: _________
Are you / your spouse pregnant? ______ If so, what is the due date? ________________
Do(es) your child(ren) have health insurance? ______ If so, what is the cost? _________
Do(es) your child(ren) attend day care? _________ If so, what is the cost? _________
INFORMATION ABOUT YOUR CASE:
Explain what type of case you have:
Special Circumstances Regarding your case:
Fee Quoted:
Retainer: __________________ Hourly Rate: _______________________
** Due to the sensitive nature of a family law practice, we do not send out letters of nonrepresentation. Until such time as you have formally retained our firm (both attorney and client have signed the Fee Agreement and client has provided the initial retainer amount), the firm of MOORE, MASUNAS AND MOORE, P.L.L.C., does not represent you.
Signature and date
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