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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