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Client Questionnaire
AFLC Client Questionnaire
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So that your lawyers and their team may best fight for you, we need to more about YOU. Please take a few minutes to complete this form to the best of your ability.
Please enter your FULL LEGAL NAME
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Have you ever used a DIFFERENT NAME?
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Please list any other names you have used and what period of time they were used.
Your Current Address
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Street Address
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Have you lived anywhere else in the last FIVE Years?
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Yes
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Please list where and for how long you lived in each other location during the last five years.
CONTACT INFORMATION
We NEED to be able to reach you, so please share as many numbers and emails as you can below.
Your BEST Email Address
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Email Address
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Are there any other email addresses we should know, including your friends and family in case we really need to get ahold of you?
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Please list any other email addresses including those of your friends and family.
Your Best Phone Number
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May we text this number?
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Are there any other Phone Numbers we should know, including your friends and family in case we really need to get ahold of you?
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Please list any other phone numbers including those of your friends and family.
Whenever possible, what is the best time of the day to reach you?
Morning
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EMPLOYMENT
Are you CURRENTLY Employed
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No
Employer Name
Position Title and For How Long?
Please describe your Position briefly
Have you worked anywhere ELSE in the last FIVE years?
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Yes
No
Please list where, when, your title and duties for EACH position you've worked in the LAST FIVE Years.
EDUCATION
Are you a HIGH SCHOOL Graduate?
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No
Please enter your High School NAME and GRADUATION YEAR.
Did you complete any additional schooling or attend any other vocation training?
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No
Please enter the school name, degree, date and other information regarding this additional education.
CRIMINAL HISTORY
Have you ever been CONVICTED of a Felony(s)?
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Yes
No
For your MOST RECENT conviction, in which City and State were you convicted?
The Date of the Conviction?
Court Case Number, if known
Please List the Offense
Are there ANY OTHERS Felony Convictions on your record?
Yes
No
Please share the location, dates, charges and court/case numbers below.
POTENTIAL WITNESS(s)
Is there anyone who you think may be able to provide support to your claims?
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Yes
No
Please list those people's names, their relationship to you, address, telephone numbers, and a short explanation of what information that you think they may be to provide.
SERVICE / MAINTENANCE
Are there any service or maintenance issues related to your case?
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Yes
No
Please list all service and maintenance you can recall having done on your Vehicle (where it was done, when it was done, what was done).
DRIVERS LICENSE
Do you have a current, valid Drivers License?
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Yes
No
From Which State?
What type (leave blank if regular)?
What is the License Number?
How long have you been licensed here?
Do you have any restrictions on your license?
Are you now or have you been licensed in a DIFFERENT state in the past FIVE Years?
Yes
No
Please provide the State, Date, Type and Number (if known) of any other Drivers License(s) you held.
NATIVE LANGUAGE(s)
Are you able to SPEAK English easily and fluently?
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No
If not in English, what other language(s) and dialect do you normally SPEAK?
Are you able to WRITE AND READ English easily and fluently?
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Yes
No
If not in English, what other language(s) do you normally WRITE & READ?
EMERGENCY CONTACTS
List the name, relationship, address, phone number(s) and address(s), if known, for those that we should contact if we need to get in contact with you and cannot.
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