Consultation Application for Individuals

In preparation for your upcoming consultation, please complete the following application as completely as possible. Since your time together over the phone is limited, having this information prepared prior to your consultation will allow Ms. Amrine to make the best use of your time and evaluate your situation. Please also email/upload copies of any of the additional items listed below that you may have : - Latest bank/investment statements - Copy of deed to real property (or property tax bill) - If applicable, Military discharge papers (DD-214) - Any life or long term care insurance policies, - Current Estate Plan Documents *In-Person Consultation Only: If you do not have access/ability to scan and email these documents prior to your consultation, please prepare and bring copies of your documents to our office.

Today's Date

MM

DD

YYYY

Name of Client:*

Prefix First Middle Last Suffix

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address (If different from Physical Address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Date of Birth (DOB:*

MM

DD

YYYY

Age*

Social Security Number (SSN):*

Occupation:*

Employer's Name

Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you a US Military Veteran?:*

Yes
No

Email Address:*

Name of closest Relative NOT living with you:*

Prefix First Last Suffix

Closest Relative's Relationship to you:*

Closest Relative's Address:*

Street Address Address Line 2 City State ZIP Code

Closest Relative's Phone Number:*

How did you hear about Amrine Law?:*

Legal consultation services by Amrine Law, hereinafter called "attorney", are rendered upon the following terms and conditions: 1. All costs and necessary disbursements, incurred by Attorney in advancing cause are to be borne by client in addition to fees for legal services. 2. Client agree that statements for legal consultation services and costs are due and payable upon receipt, unless other arrangements have been made. 3. Attorney is authorized at Attorney's sole discretion to disclose any and all information to any person whomsoever in the furtherance of client's cause. Attorney may communicate with client of others by email which may be in unencrypted form unless client notify Attorney in writing to the contrary. 4. Client understands that Attorney has made and will make no promise or guarantee regarding the outcome of any matter for which legal services are sought by client. 5. In the processing of client's case, Attorney may utilize secretaries, paralegals, law clerks and other non-counsel personnel of Attorney's choosing. 6. Client will be billed for consultation services at the following rates: Attorney Amrine: $350/hour. 7. This is an agreement for CONSULTATION ONLY. This application does not obligate Attorney, a) to accept the case, or b) to perform legal services and does not constitute a contract between the applicant and Attorney.

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Consultation Application (Individual)