Client Questionnaire - Auto Fraud Legal Center

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 list any other names you have used and what period of time they were used.

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.

Please list any other email addresses including those of your friends and family.

Your Best Phone Number*

Please list any other phone numbers including those of your friends and family.

EMPLOYMENT

Employer Name

Position Title and For How Long?

Please describe your Position briefly

Please list where, when, your title and duties for EACH position you've worked in the LAST FIVE Years.

EDUCATION

Please enter your High School NAME and GRADUATION YEAR.

Please enter the school name, degree, date and other information regarding this additional education.

CRIMINAL HISTORY

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

Please share the location, dates, charges and court/case numbers below.

POTENTIAL WITNESS(s)

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

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

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?

Please provide the State, Date, Type and Number (if known) of any other Drivers License(s) you held.

NATIVE LANGUAGE(s)

If not in English, what other language(s) and dialect do you normally SPEAK?

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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AFLC Client Questionnaire