New Client Questionnaire

Please understand that completion of this form is not a contract for legal services between yourself and the Wenger law firm.  Prior to the performance of any legal services by the Wenger law firm or any of its employees or agents, you must execute a separate retainer agreement and submit the intial retainer fee as discussed.

Please provide the following information. Please note that you must complete all information in order to submit the form. If a question is not applicable, simply input "N/A." If you do not yet have the required information, input "Unknown." As soon as you have more information, such as your new address, please provide it to us immediately.

1. Full client name (individual or business name):
 *
 
2. Mailing address (street address city state zip code and country):
 *
 
3. Billing address (street address city state zip code and country):
 *
 
4. Contact person for billing purposes (name and title):
 *
 
5. Telephone numbers (business home and mobile if applicable):
 *
 
6. Fax numbers (Please note if these are secure lines where we can transmit confidential information):
 *
 
7. Email address (Please note if this is a secure address where we can send confidential information):
 *
 
8. Point of contact (name & title):
 *
 
9. Social Security Number (SSN) if individual:
 *
 
10. Employer Identification Number (EIN) if business:
 *
 
11. How did you hear about firm?
 *
 
12. Comments or Inquiries:
Do not enter anything in this field:

* indicates a required field