Consultation Form

First Name:

Last Name:

DOB:

Business Name:

Address:

City:

State:

ZIP:

Home telephone:

Fax:

Email:

Employer:

Employer Email:

Please provide a brief description of your case:

Served with Papers? Served with Papers? yes No

When:

Court Date:

Judge:

Names of associated and/ or related parties

Name of Opposing counsel:

Other Side Name:

Additional information

Spouse Name:

Spouse Employer:

Referred by:

Have you or anyone you know been contacted by Marian Hadjichristiofi FIrm before? Who? (please provide name, address and phone number)

Have you spoken to an attorney on this matter? (Please provide name, address and phone number)