Personal Information and Intake Form

Primary Client Legal Name

First NameMiddle NameLast Name

Will this be a joint representation with a spouse or someone else?

How many Co-Clients (non-spouses) will be signing the engagement agreement?

Primary Client Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Primary Client Email*

example@example.com

Primary Client - Electronic Signature

Rows	Yes	No
It is okay to send the engagement agreement via email to be signed by electronic signature?

Primary Client Cell Phone Number

Country CodeArea CodePhone Number

Spouse Legal Name

First NameMiddle NameLast Name

Spouse Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Spouse Email

example@example.com

Joint Client - Spouse -Electronic Signature

Rows	Yes	No
It is okay to send the engagement agreement via email to be signed by electronic signature?

Spouse Cell Phone Number

Country CodeArea CodePhone Number

Co-Client 1

First NameMiddle NameLast Name

Co-Client 1 Relationship to Primary Client

Co-Client 1 Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Co-Client 1 Email

example@example.com

Co-Client 1 - Non-Spouse -Electronic Signature

Rows	Yes	No
It is okay to send the engagement agreement via email to be signed by electronic signature?

Co-Client 1 Cell Phone Number

Country CodeArea CodePhone Number

Co-Client 2 Legal Name

First NameMiddle NameLast Name

Co-Client 2 Relationship to Primary Client

Co-Client 2 Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Co-Client 2 Email

example@example.com

Co-Client 2 - Non-Spouse -Electronic Signature

Rows	Yes	No
It is okay to send the engagement agreement via email to be signed by electronic signature?

Co-Client 2 Cell Phone Number

Country CodeArea CodePhone Number

Co-Client 3 Legal Name

First NameMiddle NameLast Name

Co-Client 3 Relationship to Primary Client

Co-Client 3 Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Co-Client 3 Email

example@example.com

Co-Client 3 - Non-Spouse -Electronic Signature

Rows	Yes	No
It is okay to send the engagement agreement via email to be signed by electronic signature?

Co-Client 3 Cell Phone Number

Country CodeArea CodePhone Number

Please list contact information for all additional co-clients not already listed above

Please upload a photo ID for each client

Prospective Client Information Form