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Saedi Law Group: Initial Consultation Form
Please take a few minutes to fill out your detailed financial history below. This will help us assess your best financial options. All of the information provided to our firm is protected by the attorney client privilege.
1
Personal Information
2
Spouse Information
3
Assets
4
Income and Expenses
5
Outstanding Debts
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1
Personal Information
2
Spouse Information
3
Assets
4
Income and Expenses
5
Outstanding Debts
Name
*
First
Middle
Last
Suffix
Previous Name (if applicable)
First
Middle
Last
Suffix
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
County You Reside In
*
Cherokee
Clayton
Cobb
DeKalb
Douglas
Fulton
Gwinnett
Henry
Newton
Rockdale
Banks
Barrow
Dawson
Fannin
Forsyth
Gilmer
Habersham
Hall
Jackson
Lumpkin
Pickens
Rabun
Stephens
Towns
Union
White
Carroll
Coweta
Fayette
Haralson
Heard
Meriwether
Pike
Spalding
Troup
Bartow
Catoosa
Chattooga
Dade
Floyd
Gordon
Gordon
Murray
Paulding
Polk
Walker
Whitfield
Email
*
Phone
*
###
-
###
-
####
Social Security Number
How did you hear about us?
*
Please select
Letter
Referral
Internet
TV
Facebook
Instagram
Please check all that apply
Pending lawsuit
Garnishment
Pending foreclosure
Repossession
Bank account frozen
Tax levy
Excessive debt
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
Have you resided at any other address in the past 3 years?
*
Yes
No
Please list the address AND the dates you lived there in the past three years OTHER than you current address.
Have you filed for bankruptcy in the past 8 years?
*
Yes
No
List all prior bankruptcy cases in the last year and if your case was dismissed, please tell us WHY the case was dismissed.
An extra motion is required on refile cases in order to continue the bankruptcy protection so please provide this information. Otherwise a motion cannot be filed.
Any repossessions in the last year?
*
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 transferred or given away any property in the last 4 years?
*
Yes
No
Please provide the name of the person you transferred the property to, when you did the transfer,the type of property (address if this was real estate), and how much money you receive for the transfer.
Are you self-employed or a 1099 contractor?
*
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 please provide the following:
1. Type of business
2. Date that you started business
3. Date that you closed business(if closed)
4. EIN number
5. Inventory value
6. Accounts receivable value
7. Equipment value
How much money have your earned 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
Do you pay child support or alimony?
*
Yes
No
Please provide the name and LAST KNOWN address of the person who receives this support payment.
You also need to provide the name of the government agency you pay this payment to as well if this is court ordered.
The court requires this information and if you have to add this on later in your case there is $231 fee to do so. If you are not sure of the recipient's current address please provide the last known address for this person.
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