Conflict Check and Matter Information Form

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?

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

Assistant First Name

Assistant Last Name

Assistant Email Address

Assistant Phone Number