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Intake Form Daniel Albert
Please filed Out the Intake form and complete the $85 payment to schedule your appointment with the attorney Daniel Albert.
Full Name
*
First Name
Last Name
Birthday Date
-
Month
-
Day
Year
Date
E-mail
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer & Job Title?
*
Explain in detail your situation
*
List Your Specific Questions for your attorney
*
Marital Status:
Single
Married
Separated
Divorced
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What legal action(s) were you involved in previously, if any?
Do you currently have a will?
*
Yes
No
Do you own your own home?
*
Yes
No
Do you own a business
*
Yes
No
Do you need a legal assistance for any immigration status?
*
Yes
No
Would you like a free consultation for your next visit ($85 value)?
*
Yes
No
Would you like to participate in our referral program (10% discount)?
*
Yes
No
Payment Options?
Credit card
Debit card
Paypal
How do you like to have the meeting?
Zoom (Video)
Phone Call
In Person
Appoinments will be by phone since Tuesday August 2 to 11?
I agree
Signature
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30 Min Consultation
$
85.00
Appointment 30 Min
Payment Methods
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Credit Card Number
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Card Expiration
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