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Criminal Case Evaulation

Personal Information
Mr.   Mrs.   Ms.
First Name:
Last Name:
Date of Birth:
U.S. Citizen: 
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If you are not an U.S. citizen, there may be significant immigration consequences to a criminal conviction.
Home Address:
Apt or Suite Number:
City:
State:
Country:
Zip:
Home Phone Number:
Cell Phone Number:
Pager Number:
Fax Number:
Alternate Number:
Home eMail:
Employer Information
Employer:
Your Job Title:
Work Address:
Suite or Office Number:
City:
State:
Country:
Zip:
Work Phone Number:
Work eMail Address:
An attorney will respond to your request as soon as possible - how would you prefer we contact you?
Work Phone
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eMail Only
Details
Are you completing this form on behalf of someone else?
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If yes, please provide your contact information:
First Name:
Last Name:
Phone Number:
eMail Address:
Relationship to Subject:
Briefly explain what you may need advice about or assistance with:
Are we the first attorneys you have consulted regarding this matter?
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Ideally, if things turn out precisely the way you want, what would the outcome be?
Knowing that there are no guarantees, what can you accept?
Do you have a court date? Where is it and when?
How would you pay for fees in this matter?
Check
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Cashier's Check, Money Order
Cash
Contingency Fee
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