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Phone Number
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Area Code
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Please indicate your profession (please check one):
Attorney
Accountant
Insurance
Mortgage
Charity
Other
Attorney - please indicate the top two or three areas that are a "substantial" area of your practice:
Wills / Trusts / Estate Planning
Probate / Guardianship
Trust / Estate Litigation
Estate Tax Returns
Creation of LLC, Corporations, Partnerships
Medicaid Planning / Apply for Medicaid
Special Needs Trusts
Creation of Charitable Foundations
Bankruptcy
Social Security Disability
Real Estate Buying / Selling
Workman's Comp
Contracts / Business
Business Succession
Landlord / Tenant
Divorce / Prenuptial Agreements
Personal Injury
Employment
Criminal / Traffic Tickets
Medical Malpractice
Other - please fill in below "comments" section
Accountant - please indicate what areas are a "substantial" area of your practice:
Individual Income Tax Returns - 1040
Trust Income Tax Returns - 1041
Federal Gift Tax Returns - 709
Federal Estate Tax Returns - 706
LLC Income Tax Returns - 1065
Corporation Income Tax Returns - 1120
Business Services, Payroll, Bookkeeping
Auditing
Other - please fill in below "comments" section
Financial Advisor - please indicate what areas are a "substantial" area of your practice:
Investing
Retirement Planning
College Planning
Long Term Care
Employee Benefits
Fee-Only Financial Planning
Life Insurance Planning
Other - please fill in below "comments" section
Insurance - please indicate what areas are a "substantial" area of your practice:
Life Insurance
Commercial Insurance
Casualty Insurance
Liability Insurance
Other - please fill in below "comments" section
Mortgage - please indicate what areas are a "substantial" area of your practice:
Home Financing
Refinancing
Home Equity Line of Credit
Reverse Mortgages
Student Loans
Commercial Loans
Help with Foreclosure
Other - please fill in below "comments" section
If Probate / Guardianship - what counties?
Cook
DuPage
Will
Lake
Kane
McHenry
Other - please fill in below "comments" section
Charity - please indicate what areas are a "substantial" area of your charity:
The Homeless
The Poor
The Hungry
Children / Kids
Women
Special Needs
Religion
Animals
Environment
International
Health
Veterans
Education
Art and Culture
Other - please fill in below "comments" section
Would you be willing to enter into a co-counsel relationship with us?
Yes.
No.
May we refer our clients to you?
Yes.
No.
Would you like to schedule a short meeting with Ted Kuczek to talk about working together?
Yes.
No.
Do you have any local charities that you would like us to add to our "5% Give Back" charity list? Please list them!
Would you like to be added to our "5% Give Back" charity list?
Please add any comments and then press Submit Form below. Thank you!
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