EmailMe Form - Saedi Law Group: New Client Information

EmailMeForm

Name *
First Middle Last Suffix
Previous Name (if applicable)
First Middle Last Suffix
Social Security Number
Date of Birth *
MM / DD / YYYY
Are You Married? *
Yes
No
Spouse Name (If filing together)
First Middle Last
Spouse Previous Name (If filing together)
First Middle Last
Social Security Number
Date of Birth
MM / DD / YYYY
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Phone *
### - ### - ####
Email *
Prior Address in last 3 years
How did you hear about us? *
Please check all that apply
Pending lawsuit
Garnishment
Pending foreclosure
Repossession
Bank account frozen
Tax levy
Have you filed for bankruptcy in the past 8 years? *
Yes
No
Any repossessions in the last year? *
Yes
No
Has far as you know has our law firm ever represented your ex-spouse, current spouse, or any other party you were or are adverse to? *
Yes
No
If you have had a repo in the year who, what, when and were was repossessed? What was the value of the property repossessed?
Any lawsuits or judgments in the last year? *
Yes
No
If you have had a lawsuit in the past year what happened in that case?
Do you have any pending claims or lawsuits against anyone for any reason?

PLEASE NOTE THAT IF YOU DO AND THIS IS NOT DISCLOSED YOU WILL BE PREVENTED FROM COLLECTING ANY MONEY *
Yes
No
If you do have a pending lawsuit or claim against anyone for any reason please provide the details here. If you retained an attorney please provide their information here has well.
Have you paid back any friends or family members in the last 12 months? *
Yes
No
If you did pay back any friends or family members in the past year please provide the family member's name, address, amount repaid, and when it was repaid.
Any foreclosures in the past year? *
Yes
No
Have you transferred or given away any property in the last 2 years? *
Yes
No
Have you had a business in the last 5 years? *
Yes
No
If you have had a business in the last 5 years what kind of business did you have and did you have any partners?
If you answered YES, please list the name of the business, date started and closed, EIN info, and type of business.

Business Name

Date Started

Date Ended

EIN

Type of Business
Are you self-employed or a 1099 contractor? *
Yes
No
How much money have your earned up until today this year? *
$ Dollars . Cents
How much money did you make last year? *
$ Dollars . Cents
How much money did you make the year before that? *
$ Dollars . Cents
Spouse income up until today (even if NOT filing)
$ Dollars . Cents
Spouse prior year annual income (even if NOT filing)
$ Dollars . Cents
Spouse annual income the year before that (even if NOT filing)
$ Dollars . Cents
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Business Name
Date Started
Date Ended
EIN
Type of Business