PLDRC NEW MATTER INTAKE FORM
new matter intake form
( NEW CLIENT ( EXISTING CLIENT DATE:_____________
( CORPORATE / ( INDIVIDUAL CLIENT NAME:
__________________________________________________________________
[IF EXISTING CLIENT, REST OF THIS PAGE NEED NOT BE FILLED OUT]
client address:
Street Address: ____________________________________________
Suite: ___________________________________________________
City: __________________ State: ______________ Zip: __________
IF CORPORATE CLIENT, CONTACT NAME:
_____________________________________________________
BUSINESS PHONE:________________________________________
MOBILE PHONE: _________________________________________
home PHONE: _________________________________________
FAX NUMBER: ___________________________________________
EMAIL ADDRESS: _________________________________________
*****************************************************************
alternative contact PERSON:
Name: __________________________________________________
Street Address: ____________________________________________
Suite: ___________________________________________________
City: __________________ State: ______________ Zip: __________
Business Phone:________________________________________
Mobile Phone: _________________________________________
MATTER TYPE: ( Litigation
( Transactional / General Business
ENGAGEMENT LETTER TYPE:
( Standard Contingency – 40%
( Standard Contingency – ____ %
( Litigation Hourly
( General Business Hourly
( Three Party Hourly [Third party name:____________________]
( Other
DEPOSIT REQUIRED? ( Yes ( No Amount: $_________________
RESPONSIBLE ATTORNEY (Circle one): NP DEH TAM
********************************************************************
LAWSUIT NAME (if applicable): _________________________________
COURTHOUSE (if applicable): ___________________________________
CASE NUMBER (if applicable): ___________________________________
NATURE OF ENGAGEMENT: ___________________________________
_______________________________________________________________
_______________________________________________________________
**************************************************************
DEVELOPING ATTORNEY: ____________ NP approval (
**************************************************************
REFERRAL FROM (if applicable): _______________________________
REFERRAL FEE? ( Yes ( No REFERRAL PERCENTAGE: ____ %
REFERRAL ATTORNEY ADDRESS:
Firm Name: ______________________________________________
Street Address: ____________________________________________
Suite: ___________________________________________________
City: __________________ State: ______________ Zip: __________
IMPORTANT case information
ANY STATUTE OF LIMITATIONS OR OTHER CRITICAL DATES?
Statute of limitations: _______________________
Trial date set: _____________________________
Other critical dates:_________________________
BRIEF DESCRIPTION OF STATUS:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
PLDRC INTERNAL INTAKE CHECKLIST:
Engagement Letter
( Engagement letter prepared ___
( Engagement letter sent to client ___
( Engagement letter signed by client and returned to PLDRC ___
( Engagement letter signed by NP and fully executed agreement transmitted to client ___
Fee Sharing Letter (applicable? ( Yes ( No)
( Fee sharing letter prepared ___
( Fee sharing letter sent to client ___
( Referral thank you note to referring person (with executed fee sharing letter) ___
( Fee sharing letter signed by client and returned to PLDRC ___
( Fully executed fee sharing letter sent to referring attorney ___
Client number creation and distribution
( Client number issued by JJP [Quickbooks and Timeslips] ___
( Client number added to master client number list ___
( Client number input into printer/scanner ___
Files, documents, internal records
( All files and documents received from client or prior counsel ___
( PLDRC files created ___
( Client and referral attorney contact information input into Contacts ___
( Electronic folders set up in Active Clients on network ___
( Matter added to Master To Do list ___
( Conflict check performed ___
Substitution of Attorney (applicable? ( Yes ( No)
( Substitution of attorney form created ___
( Substitution of attorney form to client for signature ___
( Substitution of attorney form returned by client to PLDRC ___
( Substitution of attorney form signed by prior counsel ___
( Substitution of attorney form filed ___
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