Clark & Bellamy New Client Intake Form

New Client

Client contact information and reason for engaging Clark & Bellamy’s legal services

Formal Name of the Client*

The owner and contact person might differ. Identify the client here.

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Client Street Address

Please provide a Physical Street Address and list any PO Box or mail drop below.

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Apartment, suite, PO Box, mail drop, etc

If applicable, you may list the Client’s PO Box or Mail Drop for the mailing address.

Address*

Street Address Address Line 2 City State ZIP Code

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City, State, Zip (Client)

Email Address (Client)*

The client will enter a separate address for the primary contact person or employee if different than the client.

Entity Type (if applicable)

If the client is a business, please select an entity type.

Other Entity Type

State Organized (if LLC/Corporation, etc)

Land Phone Number (Client)

Mobile Phone Number (Client)

Fax (Client)

Contact Person is Same as the Owner?*

Yes

(IF DIFFERENT THAN THE CLIENT)

Name of Contact Person

Title of Contact Person

Email Address (Contact)

Land Phone Number (Contact)

Mobile Phone Number (Contact)

Street Address (Contact)

Apartment, suite, etc (Contact)

City, State, Zip (Contact)

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DESCRIPTION OF THE SERVICES REQUESTED*

Please describe the specific legal services that you request Clark & Bellamy to provide the client.

Agreement*

By clicking the Submit button below you electronically agree to Clark & Bellamy, P.C.’s website Terms of Use, Privacy Policy, and the Firm’s General Engagement Terms.

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