Client Intake Form

Client Intake Form

The more information you provide the more familiar we can become with your case. We intend to review this information before your consultation, to ensure we can discuss your questions more thoroughly.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Place of Birth*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Drivers License*
Social Security Number (Last four digits)*
Best contact number where we may reach you*
Address where you prefer to receive mail *
Secure Email Address*
example@example.com
If you have an existing case, please provide case number and county of jurisdiction.
What type of case do you need representation for?*
Employment Status

EmployedUnemployedSelf Employed
Name of Employer
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Length of Employment
Education Level
Gross Salary per Month
Name of Spouse

First NameLast Name
Address of Spouse

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Spouse
Please enter a valid phone number.
Email of Spouse
example@example.com
Spouses Date of Birth

MonthDayYear
Date
Spouse's Place of Birth
Spouse's Drivers License
Spouse's Social Security Number (Last 4 digits)
Spouse's Employer
Spouse's Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Length of Employment
Education Level
Monthly Income
How long have you lived in Texas?
What county do you reside in?
How long have you resided in this county?
Does your spouse have an attorney? If so, please provide their name and contact information, if known.
Have you been married previously?
If so, how many times?
Do you have children from the previous marriage?
Do you pay/receive child support?
If so, how much per month
With whom do these children reside?
Has your spouse been married previously?
If so, how may times?
Do they have children from the previous marriage?
With whom do these children reside?
Does your spouse pay/receive Child Support?
If so, how much per month?
Do you currently have any accounts with the following social networks?

FacebookInstagramOther
Who were you referred by or how did you hear about us?

Today's Date

MonthDayYear
Date
Expected Date of Marriage

MonthDayYear
Date
Where will marriage take place?
Will you be Husband or Wife in this marriage?
Have wedding invitations been sent out

YESNO
What other plans have been made and/or carried out for the wedding?
Do you feel pressured to enter into a prenuptial agreement?
The prenuptial agreement is desired by?
Your main goals for the prenuptial agreement are as follows : (to separate inheritance or gifts: to address assets in the event of divorce; to address assets int he event of death; to provide spouse support, etc).
How do you goals differ from your fiance's goals?
What issues do you foresee with the negotiations of the prenuptial agreement?
Does your fiance have an attorney? If so, please provide their name and contact information.
What decisions have you already made about your prenuptial agreement?
Has your intended spouse made any economic contributions to you (including supporting you while you pursued a professional interest)?

Mark (If a design or Logo, please attach. If a non-traditional mark, please describe:)
Any meaning or translation for the mark?
Goods/Services associated with the mark and/or anticipated International Classes:
WHEN? As of what date(s) or when are you expecting to use the mark? (DATE) If use of the mark was on a different goods/services at different times, please list on which goods/services the mark has been used and on which dates.
WHO? Any use by license or other affiliate of mark owner? Please list and state relationship of owner:
HOW? Please attach samples or indicate URL of website where mark can be seen displayed with goods/services:
Owner's Full Legal Name: blanks Owner's Complete Address blank
If your business entity will own the mark, please provide the full name of the entity and address connected.
Name and title of officer, partner, member or individual authorized to sign on behalf of the entity.

Other Pertinent Info:[Please provide us with any other information that may be relevant to the use/registration of the intended mark in the U.S., including use/registration in other countries and any competitor’s use/registration of a similar mark]:
TRADEMARK CLASSES (GOODS)

This list shows what each class generally covers. Use the Trademark ID Manual to determine which class or classes cover your goods and services.

Goods
001 Chemicals
002 Paints
003 Cosmetics and cleaning preparations
004 Lubricants and fuels
005 Pharmaceuticals
006 Metal goods
007 Machinery
008 Hand tools
009 Electrical and scientific apparatus
010 Medical apparatus
011 Environmental control apparatus
012 Vehicles
013 Firearms
014 Jewelry
015 Musical instruments
016 Paper goods and printed matter
017 Rubber goods
018 Leather goods
019 Non-metallic building materials
020 Furniture and articles not otherwise classified
021 Housewares and glass
022 Cordage and fibers
023 Yarns and threads
024 Fabrics
025 Clothing
026 Fancy goods
027 Floor coverings
028 Toys and sporting goods
029 Meats and processed foods
030 Staple foods
031 Natural agricultural products
032 Light beverages
033 Wines and spirits
034 Smokers' articles

Services
035 Advertising and business
036 Insurance and financial
037 Building construction and repair
038 Telecommunication
039 Transportation and storage
040 Treatment of materials
041 Education and entertainment
042 Computer and scientific
043 Hotels and restaurants
044 Medical, beauty and agricultural
045 Personal and legal
Should be Empty:

	Child Full Name	Date of Birth	Social Security # (last 4 digits)	Where does the Child reside?	Other Parents Full Name
Child 1
Child 2
Child 3
Child 4

	Source Name	Type* (S=Salary P=Pension D=Dividends I=Interest C=Capital Gains T-Trust R=Rent O=Other	Expected Amount this Calendar Year	Amount Last Calendar Year	Amount 2 Calendar Years Ago	Significant Changes Expected
Source 1
Source 2
Source 3
Source 4
Source 5
Source 6

	Type* R=Residence I=Investment/Rental U=Unimproved Land F=Farm or Ranch C=Commercial Property V=Vacation Property	Address of property	Purchased Date	Purchased Price	FMV	Balance on Mortgage	Title Owner(s)
Source 1
Source 2
Source 3
Source 4
Source 5
Source 6

	Type	Bank	Account NO. (Last 4 digits)	Approximate Value	Owner(s)
Source 1
Source 2
Source 3
Source 4
Source 5
Source 6

	Type	Financial Institution	Account No. (Last 4 digits)	Approximate Value	Owner(s)
Source 1
Source 2
Source 3
Source 4
Source 5
Source 6

	Country/State	Mark	Application/Registration No.	Goods/Services Summary
Application 1
Application 2
Application 3
Application 4