Client Intake Form

Form
First Name*
Last Name *
Email
example@example.com
Cell phone
Work phone
Home phone
Address

Address

Address 2

CityState

Zip Code
Country
Time Zone
Birthday

MonthDayYear
Date
Company
Name of Business Entity (i.e. LLC, PLLC, Corp. etc.)
Address of Business Entity
Job title
Drivers License and State
Website
Fax number
Notes
What type of Case:*

Family LawLLC FormationChild CustodyProbateTrustWillTrademarkGuardianship

Family Law Cases

Please complete the following fields
Monthly Income
Maiden Name, if applicable
Your Social Security Number
Your Drivers License Number
Spouses Name

First NameLast Name
Spouses Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouses Email
example@example.com
Spouses Social Security Number
Spouses Drivers License Number
Spouses Employer Name, Address and Phone number
Spouses Monthly Income
Are there children of the marriage?

YesNo
Please list children's Names, Date of Birth, Gender at Birth, and Last four of Social Security Numbers.
Who do the Children currently reside with?
Is there an open, or has there ever been an open Texas Attorney General Case?

YesNo
Have you been served papers for the lawsuit?
Please provide case number.
Has either party been in the military, if so name of party.
Do the children currently have Health Insurance coverage, if so, what is the premium cost and by which parent is it being paid?

Trademark or Service Mark Formation

Please complete the fields below
If you have a design or logo please upload

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GOODS/SERVICESassociated with mark and/or anticipated International Classes
USE OF THE MARK:

(a) WHEN?
As of what date(s) or when expected to use?

If use of the mark was on different goods/services at different times, please list on which goods/services the mark has been used and on which dates?

(b) WHO?
Any use by licensee or other affiliate of mark owner? Please list and state relationship to owner.

(c) HOW?
Please attach samples or indicate URL for website where mark can be seen displayed with
goods/servic
Answers from above:
File Upload

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Owner Full Name

First NameLast Name
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
*If your business entity will own the mark, please provide the full name of the entity and address connected.Legal entity and domicile [e.g. a Texas LLC or corporation; a U.S. individual]
Name and title of officer, partner, member or individual authorized to sign on behalf of owner/applicant:
PRIOR APPLICATIONS/REGISTRATIONS[Please provide the following for any application to register, or any registration that has issued, for the subject mark]: Country/State Mark Application/Registration Number Good/Service Summary
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]
Name of Client Contact
Trademark and Service Mark Classifications

Probate,Trust & Will Information

Please complete the following fields.
Indicate full name of Will/Trust, the parties date of birth, spouses name, date of birth date of marriage, and address, city, state and county where they reside.
List of all children of deceased parent, their Date of birth, and born of what parents (relationship to party), their address, phone numbers, social security numbers? Indicate if those children are deceased or married Include all children of former marriages, stepchildren, adopted children, etc.
Was the Decedent married at the time of death?

YesNo
At the time of death, did the Decedent have a Will?

YesNo
If yes, was the Will probated?

YesNo
Decedents Place of Residence
Who will be the initial trustee, date of birth, address, city, state and county where they reside, and phone number
Who will be the successor trustees: List the date of birth, address, city, state and county where they reside, and phone number
Please provide the following documents, etc. for anything that applies to you: Copies of the GRANT DEED (not the Deed of Reconveyance) for each parcel of real property you own, including raw land and parcels located in other states. The Assessor's Parcel Number (or other identifying number) and the street address for each parcel of real property you own. The parcel number should be on your property tax bill if it is not printed on the Grant Deed. Copies of the promissory note and Deed of Trust for each secured loan you have made to others. Copies of all promissory notes for any unsecured loans you have made (including loans made to family members). Copies of your latest statements for each brokerage account and/or mutual fund you own. (Showing the account/fund number and the mailing address of the firm.) A list of your bank/credit union accounts that are to be transferred to the trust, including the name of the bank, the type of account (checking, savings, money market, CD, etc.), and the account number. We do not need to know the current balance in the account. A list of your IRAs, 403(b) accounts, TSAs, 401(k)s, Keoghs, or other tax- deferred retirement plans, their approximate current value, and the names of the primary and contingent beneficiaries on these accounts. Approximate values for any high - value collectibles you may have (art, stamps, coins, antiques, gold, etc.) and your plan for the ultimate distribution of such items. Copies of any gift tax returns you have filed for gifts of more than the annual exclusion amount. Copy of any business buy - sell agreement you may have. Copy of your partnership agreement(s) for each general partnership (or LLC) in which you are involved and the names of the other general partners. Copy of marital separation agreement, if there are ongoing spousal and/or child support obligations. Specifics on any royalties you are receiving or will be receiving (from books you have written, music you've performed, gas, oil or mineral rights you sold, etc.)

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List all Special Bequests: Item and the Recipients Names
Should be Empty:

Form

Family Law Cases

Trademark or Service Mark Formation

LLC Formation

Probate,Trust & Will Information