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1) What type of business do you have?  [required]
2) Please briefly describe the purpose of your business or industry/service sector.  [required]
3) How many employees do you have in your business?  [required]
4) What is your relationship to your business?  [required]
5) What type of Litigation services do you need?  [required]
6) Who is the other party involved in the dispute?  [required]
7) Please briefly describe the nature of the dispute. Keep your description general and do not include the name(s) of any one involved.  [required]
8) Please indicate how you would prefer to to pay for the services of an attorney, should you hire one to help you with your legal matter. Note: there is no charge to sumbit your request.  [required]
Hourly Rate
Retainer
Flat Fee
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9) Comments or Details:

Service Location:  [required]
10)
ZIP Code:  -- OR --
City/State 

Contact Information:
11)
First Name: [required]
 Last Name: [required]
12)Email Address: [required]
13)
Day Time Phone: [required]
()-x		 Evening Phone:
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14)
Best Time: [required]

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