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Conflict Check and Matter Information Form
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First Name
Middle Name
Last Name
Phone Number
Email Address
Are you reaching out as a representative of a business or yourself personally?
My business or a business I work for
Myself personally
Will anyone else be joining our call? If so, how many?
No, only me
Yes, myself and 1 more person
Yes, myself and 2 more people
Yes, myself 3 or more people
Full legal name of the other party joining the call.
Phone number of the other party joining the call.
Email of the other party joining the call.
Full legal name of the second party joining the call.
Phone number of the second party joining the call.
Email of the second party joining the call.
Full legal name, phone number and email of the third or more parties joining the call.
Legal name of the business, including subsidiaries and DBA
Current Business Address
In which state is the business incorporated?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
What is the Employer Identification Number (EIN) of the business.
Are there any business partners or other individuals involved or relevant to this matter? If yes, please provide their full names and affiliation.
What is your office or personal address.
Describe the issue or problem you need assistance with, be as detailed as necessary.
Were you referred to our firm? If so, please tell us by whom. How did you find out about Yormack Law?
Do you have an assistant?
Yes
No
Assistant First Name
Assistant Last Name
Assistant Email Address
Assistant Phone Number
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