Client Intake & Service Agreement Form

Client Intake & Service Agreement Form

Please complete this form to provide your details and agree to the terms for our consulting services.
Client Type, Identity, and Contact Information
Client type
Full legal name

First NameMiddle NameLast Name
Preferred name
Pronouns
Date of birth

MonthDayYear
Date
Primary phone number
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Physical address, if different

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred communication method
Best Contact Time
Acknowledgment
Business Responsibility and Service Request Details
Description of Requested Support or Consulting Services
Goals or Desired Outcome
Deadline or Important Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Urgency Level
Relevant Background or Context
Known Issues or Problems
Type of Matter

Other
Special Instructions, Business Responsibility, and Authorization Acknowledgment
Documents, Uploads, and Verification
Identity Document Upload

Cancelof
Business Document Upload

Cancelof
Supporting Records / Correspondence Upload

Cancelof
Email for Document Submission
example@example.com
Consultation Request, Fees, Virtual Support, and Communication
Do you request a consultation?
Acknowledge consultation fee terms

Other
Do you request priority or rush service?
Acknowledge priority or rush fee terms

Other
Consent to virtual support and remote service delivery where appropriate

Other
Acknowledge communication turnaround expectations

Other
Consent to service-related electronic communications

Other electronic communications
Privacy, Data Handling, and Electronic Consent
I understand and agree that the firm may collect and use my personal identifying information, metadata, cloud-stored records, electronic records, and physical records as needed to provide services.
I consent to the transmission and storage of my personal data through electronic systems, including secure third-party service providers, when reasonably necessary to perform services.
I authorize the firm to share my personal information with courts, agencies, opposing parties, service providers, or other persons when reasonably necessary to perform the requested services or comply with law.
I consent to use of electronic signatures, virtual signatures, and electronic recordkeeping for this matter, and I acknowledge that electronic copies may be treated as originals where permitted by law.
I understand that this form is a template for informational purposes, that attorney review is recommended, and that enforceability may depend on applicable jurisdiction and facts.
Dispute Resolution, Public/Private Protection, and Service Terms
Dispute Resolution Acknowledgment

Other
Protection of Company and Related Parties

Other
Cancellation and Refund Terms

Other
No-Guarantee Acknowledgment

Other
Truthfulness and Accuracy Certification

Other
Service Terms and Legal Limitations Acknowledgment

Other
Payment Options, Authorization, and Collection Terms
Preferred Payment Option

Other
Payment Methods You Authorize Us To Use

Other
Authorization for Payment Processing
Authorization to Charge or Debit Payment Methods
Charges You Agree To Pay
Late Payment, Returned Payment, and Nonpayment Terms Acknowledgment
Collections, Credit Reporting, and Collateral Request Acknowledgment
Payment Responsibility Acknowledgment
Fee Waiver or Reduction Request
Request Type
Eligibility Basis
Supporting Details
Proof of Eligibility

Cancelof
Attestation and Verification Consent
All payments should be made at least 12 hours before the scheduled meeting unless the fee was waived or reduced. If you do not have an invoice emailed or texted to you, put your first name and the last four of your phone number in the invoice number and enter what you are paying for in the notes or payment description.
Limited Authorization / Temporary Power of Attorney
Authorization Type
Scope of Authorized Services
Effective Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Client Acknowledgment
Required Signatures and Final Acknowledgment
Typed Name for Privacy Consent

First NameMiddle NameLast Name
Privacy Consent Signature
Date of Privacy Consent

MonthDayYear
Date
Typed Name for Service Terms and Payment Authorization

First NameMiddle NameLast Name
Service Terms and Payment Authorization Signature
Date of Service Terms and Payment Authorization

MonthDayYear
Date
Title / Role (if signing for a business)
Final Acknowledgment Signature
Free Discovery Call
Priority Strategy Session
Client Intake & Project Scoping Call
https://melio.me/SaundersManagementGroup — All payments should be made at least 12 hours before the scheduled meeting unless the fee was waived or reduced. If you do not have an invoice emailed or texted to you, put your first name and the last four of your phone number in the invoice number and enter what you are paying for in the notes or payment description.
Should be Empty:

Client Intake & Service Agreement Form

Client Type, Identity, and Contact Information

Business Responsibility and Service Request Details

Documents, Uploads, and Verification

Consultation Request, Fees, Virtual Support, and Communication

Privacy, Data Handling, and Electronic Consent

Dispute Resolution, Public/Private Protection, and Service Terms

Payment Options, Authorization, and Collection Terms

Fee Waiver or Reduction Request

Limited Authorization / Temporary Power of Attorney

Required Signatures and Final Acknowledgment