New Matter Form

Fill Out Our Matter Form to Request an Appointment

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NEW MATTER INFORMATION

Please complete this form as thoroughly as possible so that we can efficiently set up your matter and communicate with you.

Until we enter into a formal agreement to represent you, we do not undertake to represent you. However, the information you provide to us below will be held in strict confidence even if we do not enter into a formal agreement to represent you (except that if we do enter into a formal agreement to represent you, we may disclose information as needed to effectively represent you).

First, we need to determine who our client(s) will be (assuming we accept this matter and enter into an attorney-client relationship). A client is the person(s) or entity/entities who need legal representation. Usually this is the person(s) or entity/entities which will be paying our fees, but sometimes someone other than the client agrees to pay our fees for the benefit of the client(s).

Please select one of the client types below (if there are to be multiple clients or client contacts, first enter the information for one client or client contact and then you will have an opportunity to enter information for additional clients or client contacts).

Client is a person (an individual)

Client is an entity (partnership, corporation, LLC, etc.)

IF CLIENT IS A PERSON:

Full Name:*

First Middle Last

Preferred Name/Nickname:

Address:*

Street Address City State ZIP Code

Address

P.O. Box City State ZIP Code

Email Address:*

(all invoices will be emailed to this address unless you select below another method of receiving invoice)

Email invoices to email address entered above.

Email invoices to

Email:

Fax invoices to

Fax:

Mail invoices to

Address:

Primary Phone Number:*

(please check one)

Home

Mobile

Work

(please check one)

Mobile Phone Number:

Work Phone Number:

DOB:*

Social Security Number:*

Employer:*

Employer Phone Number:*

Employer Address:*

Street Address City State ZIP Code

SPOUSE/PARTNER INFORMATION*

I do not have a spouse/partner

My spouse/partner listed below will also be a client (assuming this matter is accepted for representation and an attorney-client relationship is established)

My spouse/partner listed below will not be a client, but I am providing his/her information below as an emergency contact.

Full Name:*

First Middle Last

Address:*

Street Address City State ZIP Code

P.O. Box City State ZIP Code

Email Address:*

Primary Phone Number:*

(please check one)

Home

Mobile

Work

(please check one)

Mobile Phone Number:

Work Phone Number:

If third option above (“My spouse/partner listed below will also be a client”), the following is required:

DOB:*

Month

Day

Year

Spouse/Partners’ Employer:

Name:

Phone Number:

Employer Address:

Street Address City State ZIP Code

EMERGENCY/ALTERNATE SOURCE OF CONTACT

Please list someone not living with you. Unless you have authorized us to do so, we will not discuss your matter with this emergency/alternate source of contact but if we are unable to contact you using the information you have provided, we may contact this person to find out how we can contact you:

Full Name:*

First Middle Last

Address:*

Street Address City State

Telephone:*

Why are you seeking representation/assistance? Describe the nature of your legal need or problem:*

PLEASE LIST THE FULL NAMES (AND ADDRESSES, EMAIL ADDRESSES AND PHONE NUMBERS, IF AVAILABLE) OF ALL OTHER PERSONS OR ENTITIES INVOLVED WITH YOUR LEGAL NEED OR PROBLEM. LIST PERSON/ ON THE OPPOSING / OTHER SIDE OF YOUR LEGAL NEED OR PROBLEM (SUCH AS PERSONS/ENTITIES WITH WHOM YOU HAVE A LEGAL DISPUTE OR PERSONS/ ENTITIES WITH WHOM YOU WILL BE CONTACTING), IF YOUR LEGAL NEED OR PROBLEM DOES NOT INVOLVE ANY OPPOSING SIDED ( SUCH AS THE CASE OF ESTATE PLANNING), PLEASE ENTER "NONE" (WE NEED THIS INFROMATION TO CONFIRM THAT REPRESENTING YOU IN THIS MATTER WILL NOT CREATE A CONFLICT OF INTEREST FOR OUR FIRM):*

Have you contacted another attorney or are you currently working with another attorney regarding this matter?*

Yes

If yes, explain:

Is this matter currently in litigation?*

Yes

Do you believe that there is a reasonable possibility that this matter will result in litigation?*

Yes

Let us know how you chose Garvin Agee Carlton, PC:

Referral

(Referred by)

Internet

(search engine)

Other

YOUR INITIAL CONSULTATION*

I have already scheduled an initial consultation.

Please contact me to schedule an initial consultation. (Include any special requests/instructions for initial consultation in the "Other Information" box below.):

Please specify

OTHER INFORMATION

Please enter here any additional information which you believe will be helpful to us:

Please enter your name below as an electronic signature:

I acknowledge that submission of this form:

a. Is for the sole purpose of providing Garvin Agee Carlton, P.C. and its employees (collectively, “GAC”), with information to assist GAC with determining whether undertaking of this legal matter is appropriate, and

b. does not mean that GAC has agreed to undertake representation in this matter, and GAC will not undertake representation in this matter until an agreement to do so has been reached.

Electronic Signature*

Date*

MM slash DD slash YYYY

IF CLIENT IS AN ENTITY:

Full Name of Entity:*

(Use full legal name exactly as recorded with the secretary of state or other government agency with whom the entity is registered, including Inc., Co., LLC, etc.)

Under whose law the entity is organized?

Oklahoma

Texas

Other:

Please specify:

Entity's Address:*

Street Address City State ZIP Code

P.O. Box: City State ZIP Code

Entity’s Primary phone number:*

(please check one)

Mobile

Work

(please check one)

Entity’s Email Address:*

(all invoices will be emailed to this address unless you select below another method of receiving invoice).

Email invoices to email address entered above.

Email invoices to

Fax invoices to

Fax

Mail Invoices to

Address

Invoices should include (optional):

Attn: Accounts Payable

Invoices should include (optional):

Attn:

(enter name of department or person who will be approving our invoices for payment)

Invoices should include (optional):

Other reference to assist entity’s personnel in handling our invoices:

Please specify:

CLIENT CONTACTS

Next, we need information about the Entity’s owners and employees who are involved with the Entity’s legal matter. First enter the information for the person who will be the primary contact at the Entity.

Why are you seeking representation/assistance? Describe the nature of your legal need or problem:*

Please list the full names (and addresses and phone numbers, if available) of all other persons or entities involved with your legal need or problem. We need this information to confirm that representing you in this matter will not create a conflict of interest for our firm:*

Have you contacted another attorney or are you currently working with another attorney regarding this matter?*

Yes

If yes, explain:

Is this matter currently in litigation?*

Yes

Do you believe that there is a reasonable possibility that this matter will result in litigation?*

Yes

Let us know how you chose Garvin Agee Carlton, PC:

Referral

from

(let us know who so we may send a thank you for the referral)

Internet

(search engine)

Firm/Attorney reputation

Previous/Existing Client

Other

YOUR INITIAL CONSULTATION*

I have already scheduled an initial consultation.

Please contact me to schedule an initial consultation. Special requests/ instructions for initial consultation (optional):

Please specify

OTHER INFORMATION

Please enter here any additional information which you believe will be helpful to us:

Electronic Signature*

Date*

MM slash DD slash YYYY

Consent

I agree to the privacy policy.

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Second Choice

Third Choice

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New Matter Form

Fill Out Our Matter Form to Request an Appointment

NEW MATTER INFORMATION

IF CLIENT IS A PERSON:

EMERGENCY/ALTERNATE SOURCE OF CONTACT

IF CLIENT IS AN ENTITY:

CLIENT CONTACTS

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