Fill and Sign the Client Questionnaire Bankruptcy Worksheet Form

Client Intake Sheet File Number: __________________________Date Form Completed: ___________________________ [ ] New Client[ ] Prior Client Client’s Name: ______________________________________ Soc. Sec. No.______________________ Name of Spouse: _____________________________________ Soc. Sec. No._____________________ Address: _____________________________________________________________________________ Home Telephone: ______________________________________________________________________ Name of Employer: ____________________________________________________________________ Work Telephone Number: ___________________________Spouse’s Employer: ____________________________________________________________________ Spouse’s Work Telephone Number: ___________________________________ Name of Emergency Contact: ___________________________________________________________Relationship to Client: __________________________________________Telephone No. of Contact: _________________________________Name of Case: ________________________________________________________________________ Area Of Law: ________________________________________________________________________ Originating Attorney: __________________________________________________________________Assigned Attorney(s): __________________________________________________________________ Referred By: _________________________________________________________________________ Conflict Check (Initial when completed): ___________________________________________Engagement Letter (Initial when completed):________________________________ Statute Of Limitations or Time Deadline: __________________________________________________Litigated Matters Name of Court: ________________________________________________________Style of Case: _________________________________________________________________________Case Docket No.: _________________________________________Name of Judge: _______________________________________________________________________Name of Opposing Counsel: _____________________________________________________________Address of Opposing Counsel: ___________________________________________________________Phone Numbers of Opposing Counsel – Office: ____________________; Fax: ____________________E-Mail of Opposing Counsel: _________________________________Date Answer Due if Defending_________________________________________Discovery Deadline: __________________________________________________________________