Divorce Intake Form Divorce Intake Form Please fill out the details of your case below so we may better serve you. * Your Name: First Last * Spouses Name: First Last * Your Date of Birth: * Spouses Date of Birth: * Your Address: Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP Code * Home Phone: Cell Phone: * Your Email: * If You Retain May We Email You Reguarding Your Case? Yes No * Preferred Method/Telephone Number To Contact You: * Year Married: * Husbands Age: * Wifes Age: * State Married: * Separation Date: Ages of Children Born of Marriage: * Are You Both Seeking Separation/Divorce? Yes No * What Issues Are Parties In Agreement? (List Below) * Has There Been Marriage Counseling? Yes No What Is The Cause Of The Separation/Divorce? (Explain Below) * Husbands Gross Annual Income: * Wifes Gross Annual Income: Other Income: * Total Checking, Savings, Investments, etc. * Home / Real Estate Equity: * Personal Property - Vehicles, Boats, Etc.: Retirement Income: * Investment / Savings - 401K, IRA, etc. * Total Credit Card Debt: * Personal Loans * Mortgage Loans (Second Mortgage If Applicable) * Other Debt: * What Do You Want Your Attornmey To Do For You? * What Court Orders Or Written Agreements Are In Effect Now? * Is There A Pending Court Date? If So What Type? List Any Questions You Have For Us Below:
