New Client Information Sheet

Mail: 420 SW Washington Street, Suite 400, Portland, OR 97204

Phone: 503.388.6065, Fax: 503.926.9399, Web:

NEW CLIENT INFORMATION SHEET

TODAY’S DATE ______
Potential Client’s Full Name: ______
Home Address: ______
City/State/Zip: ______E-mail Address: ______
Telephone (Home): ______Cell: ______Work: ______
Can we leave detailed messages? (circle one): YES NO
Can we email you sensitive information to the account you have provided? (circle one): YES NO
Emergency Contacts:
Name: ______Relationship: ______Telephone: ______
Name: ______Relationship: ______Telephone: ______
How did you find us? ______
SPOUSE/ADVERSE PARTY:
Opposing Party’s Full Name: ______
Home Address: ______
City/State: ______Zip: ______County: ______Years living in Oregon: ______
E-mail Address: ______
Telephone (Home): ______Cell: ______Work: ______
Attorney Name: ______
Maiden Name: ______Former Legal Names:______
SS No.: ______Birthplace: ______DOB:______
Race: ______Condition of Health: ______
Educational Background (Highest grade completed):______
Occupation:______Length of Employment:______
Business & Address: ______
Hourly Earnings: _____Hours Per Week:______Monthly Gross Earnings:_____Monthly Net Earnings:______
Other Sources of Income: ______
Prior Marriage(s)Dissolved (mm/dd/yyyy):______
Marriage Date:______Numbers of Years Married:______
Place of Marriage (city/county/state): ______
Separation Date:______No. of Children Under 18:______
Prenuptial Agreement:______Started living together:______
CHILDREN
This Marriage:
Name:______DOB:______AGE: ______
Name: ______DOB:______AGE: ______
Name: ______DOB:______AGE: ______
Name: ______DOB:______AGE: ______
Who has custody? ______
Visitation schedule:______
Support paid? ______How much?______
Non-Joint Children:
Name: ______DOB:______AGE: ______
Name: ______DOB:______AGE: ______
Name: ______DOB:______AGE: ______
Name: ______DOB:______AGE: ______
Who has custody? ______
Visitation schedule: ______
Support paid? ______How much? ______
UCCJEA Information: (minor children)
Children live with: ___ Mother ____Father State other than Oregon:______(specify below)
Names and addresses of persons with whom the children have lived during the past five years
(if different from present arrangement):
______
______
______
______
______
ASSETS
Real Property
Family Residence Address:______
City/State: ______Zip: ______County: ______
Purchase Date: ______Purchase Price: ______
Monthly Payment: ______Balance Owing:______
Present Value:______
Recreational Property Address:______
City/State: ______Zip: ______County: ______
Purchase Date: ______Purchase Price: ______
Monthly Payment: ______Balance Owing:______
Present Value:______
Rental Property Address:______
City/State: ______Zip: ______County: ______
Purchase Date: ______Purchase Price:______
Monthly Payment: ______Balance Owing:______
Present Value:______Rent Received:______
PERSONAL PROPERTY
VEHICLES (including cards, trucks, boats, trailers, recreational)
Value and how
YearMake ModelLic # & State Used By value obtained
______$______
______$ ______
VALUABLES (collections, jewelry, etc.)
Value and how
Item value obtained
______$______
______$______
BANK ACCOUNTS
Bank:______Branch:______
Address:______
Account Number: ______
Savings, Checking, Money Market, Time Certificate or Other: ______
In Whose Name: ______Balance: ______
Bank:______Branch:______
Address:______
Account Number:______
Savings, Checking, Money Market, Time Certificate or Other: ______
In Whose Name: ______Balance: ______
STOCKS AND BONDS
NameNo. SharesValue
______
______
PENSION, PROFIT SHARING & STOCK PURCHASE PLANS
Husband: ______
Wife:______
INSURANCE POLICIES
Life: ______Face Amount: ______
Beneficiary: ______
Life: ______Face Amount: ______
Beneficiary: ______
Health: ______
Auto: ______
OTHER ASSETS
______
______
DEBTS
CreditorAmountWhose
______
______
______
______
______
______

FOR OFFICE USE ONLY

Fee arrangement:
Billing arrangement:
Matter description:
Conflict Control
Name: Relationship:
______
______
______
File opened by______Conflicts checked by______
Deadlines docketed by ______Engagement letter sent by: ______Date______
Notes: ______
______
______
______