Client Information Form

General Contact Information: 

First Name:

Last Name:

Street Address:

City:

State:

Zip:

E-mail Address:

Home Phone:

Work Phone:

Fax Number:

What method would you prefer we use to contact you?     Phone         E-mail       Fax

What time of day would you like us to call? Morning   Afternoon    Evening    N/A

Employer:

Address:

Spouse Info (Leave as N/A if single)

Name:

Date Of Birth:

Employer:

Employer Address:

Employer's Phone:

Children Info (Leave as N/A if none)

Name: 

Date Of Birth:  

Name: 

Date Of Birth:  

Name: 

Date Of Birth:  

Name: 

Date Of Birth:  

Is this your FIRST experience engaging the service of an attorney?    Yes          No

How were you referred to this office?

General nature of the issue for which you seek legal advice:

Yes - I agree No - I disagree
I understand and agree to the fee of $105.00 for up to one-half hour for a consultation.  If my consultation should exceed one-half hour, I understand that I will be billed at the hourly rate of $210.00 for any and all additional time spent with J.B. Thomas & Associates.  I agree to pay this consultation fee and understand that the fee for this consultation shall be applied toward the total attorney's fee if I retain the services of J.B. Thomas & Associates for this matter.