*Name:
*Address:
*City:
*State: Choose One AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
*Zip:
*E-mail address:
*Home Phone:
Business Phone:
Cellular or Pager:
Facsimile:
Are you known by any other names? Yes No
If yes, list other names you have used:
What is your marital status? Choose One Single Married Divorced Separated Widowed
Does this matter involve a business you own or run? Yes No
If yes, provide the business name, address, and phone:
If a business is involved, how is the business organized (if known)? Choose One Sole Proprietorship Partnership Limited Liability Company or Partnership Professional Corporation S Corporation C Corporation/Other
Are you employed? Yes No
If yes, please provide your job title and employer's name and address.
Can you be contacted at work? Yes No
Are you being sued? Yes No
If yes, please provide the following:
Name of the party suing you
Name, address, and telephone number of the attorney for the party suing you, if any
Name and location of the court you are being sued in
Date you were served with court papers
What area of law does your situation involve (if known)? Choose One Administrative Law Admiralty / Maritime Law Adoption Agriculture Law Alternative Dispute Resolution Animal Bites Antitrust & Trade Regulation Aviation Aviation & Mass Transit Accid. Banking / Finance Law Bankruptcy Law Business & Commercial Law Business Organizations Child Support Civil Rights Construction Law Consumer Protection Contracts Criminal Law Criminal Law / Federal Custody / Visitation Discrimination Divorce DUI / DWI Education Law Elder Law Employment Law / Employee Employment Law / Employer Energy Law Environmental Law Estate Planning Ethics/Professional Resp. General Franchising Government Agencies/Programs Govt. Contracts Health & Health Care Law Immigration/Naturalization Insurance Law Intellectual Property Law International Law Internet/Cyberspace Labor Law Landlord / Tenant Legal Malpractice Litigation / Appeals Medical Malpractice Law Military Law Motor Vehicle Accidents Nursing Home Patent Personal Injury Personal Injury/Defense Premises Liability Probate Estate Administration Products Liability Law Professional Malpractice Law Real Estate Law Science/Technology Law Securities Law Sexual Harassment Social Security/Disability State/Local/Municipal Law Taxation Law Toxic Substances Trademarks Traffic Violations Transportation Law Trusts Wills Workers' Compensation Law Wrongful Death
Describe your situation, including any relevant dates:
Are any other people involved? Yes No
If yes, provide names, addresses (if known), and their relationship to you, if any:
Do you have any documents that could help explain your situation? Yes No
If yes, list those documents and their dates:
Are there other documents that you do not have access to that could be of assistance? Yes No
If yes, list those documents and their dates and locations (if known):
Describe how this situation has impacted you:
Describe what you would like to happen to resolve your issue (your preferred outcome):
Have other attorneys worked on this matter? Yes No
If yes, provide names, addresses, and a brief description of their involvement:
Special concerns:
Where did you hear about this website? Choose One Television Ad Radio Ad Newspaper Ad Billboards Referred by a Friend Search Engine
Th
The Law Office of Jeffery J. Hernandez handles personal injury and business matters for clients throughout the State of Arizona including Phoenix, Mesa, Chandler, Tempe, Glendale, Winslow, Flagstaff, Show Low, Tucson, and Kingman
Can anyone bring a wrongful death claim?
Learn More: Plaintiff's Personal Injury Law
Law Office of Jeffery J. Hernandez
7047 E. Greenway Parkway Suite 140 Scottsdale, AZ 85254
Phone: (480) 624-2765 Fax: (480) 991-0920 E-mail the Firm