Conflict Check and Matter Information Form

First Name

Middle Name (optional)

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

Legal name of the business, including subsidiaries and DBA

Which state is the business incorporated in?

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 business address?

Business Address 1

Business Address 2

Business City

Business State

Business Zip Code

What is your personal address?

Contact Address 1

Contact Address 2 (optional)

Contact City

Contact State

Contact Zip Code

Do you have an assistant?

Yes

Assistant First Name

Assistant Last Name

Assistant Phone Number

Assistant Email Address

Describe the issue or problem you need assistance with, be as detailed as necessary.

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 and 3 or more people

Additional Party 1 Full Name

Additional Party 1 Phone number

Additional Party 1 Email

Additional Party 2 Full Name

Additional Party 2 Phone number

Additional Party 2 Email

For all additional parties, list their full names, phone numbers, and emails.

Were you referred to our firm? If so, please tell us by whom. How did you find out about Yormack Law?