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VCDS Case Information Sheet
Court Date:
Court Case #:
Today's Date:
*
Person completing this form:
*
Party 1 (Pick One):
Plaintiff
Defendant
Buyer
Seller
Name:
*
Address:
*
Type of phone #:
Please select
Home
Work
Cell
Phone #:
*
Email Address:
Atty/Agent:
Address:
Atty/Agent Phone #:
Fax #:
Party 2 (Pick One):
Plaintiff
Defendant
Buyer
Seller
Name:
*
Address:
*
Type of phone #:
Please select
Home
Work
Cell
Phone #:
*
Email Address:
Atty/Agent:
Address:
Atty/Agent Phone #:
Fax #:
Party 3 (Pick One):
Plaintiff
Defendant
Buyer
Seller
Name:
Address:
Type of phone #:
Please select
Home
Work
Cell
Phone #:
Atty/Agent:
Address:
Atty/Agent Phone #:
Fax #:
Party 4 (Pick One):
Plaintiff
Defendant
Buyer
Seller
Name:
Address:
Type of phone #:
Please select
Home
Work
Cell
Phone #:
Atty/Agent:
Address:
Atty/Agent Phone #:
Fax #:
Type of Service:
Conciliation
Mediation
Arbitration
Type of Case:
Auto
Business
Consumer
Contracts
Debt/Loans
Family
HOA
Labor
Landloard
Neighbor
Real Estate
Tenant
Other
If you chose "other" above please explain here:
Referral Source:
Court
Past Client
SHLAC
Brochure
LRIS
Mex/Con
Other
If other please explain here:
Summary of Dispute
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