Leventry, Haschak & Rodkey, LLC.
Client Services Portal | Meet Our Attorneys | Contact Us
 
Practice Areas
Administrative / Government
Bankruptcy / Creditors' Rights
Business and Corporate Law
Civil Litigation
Commercial Lending
Construction Law
Criminal Law / DUI
Elder Law / Medicaid Planning
Estate Planning and Administration
Family Law / Adoptions
Intellectual Property
Labor and Employment Law
Land Development and
Commercial Leasing
Municipal Law
Personal Injury / Accidents
Real Estate
Social Security Disability
and Workers Compensation
Tax Law

 

 

Online Client Intake Form

A printable version of this form can be found here, simply print it out, complete and bring in at the time of your appointment/consultation.

 
Client Name:
Date:
   
Address:
City & State:
Zip Code:
 
Telephone: (home)
(cell)
   
Email Address:
 
     
Birthday:
S.S. #
   
How did you learn about law firm? Referral from another client? Yes
Other (please explain):
   
CREDIT CARD INFORMATION  
   
Name on Credit Card:
Expiration Date:
Type of Credit Card:
     
Security Code on Back of Card:
Credit Card Number:
Cardholder Name: Same as Client:
     
If a credit card has been provided to Leventry, Haschak & Rodkey on the Client Information Sheet all of the terms
of which are incorporated into these Terms of Engagement, the cardholder has agreed that charges delinquent for
more than 60 days may be charged to the card provided.
 
If you have a legal plan through HYATT, please indicate a case number so that we have it for billing purposes:
 
E-mail Authorization: This form will be sent by email. You recognize that there is a possibility that an e-mail message sent between us via the Internet may be intercepted by a third party. However, balancing the risk against the convenience of such communication, you authorize us to communicate by e-mail (to you or to others) when we believe it to be at least as efficient as other methods.
 
Deed Preparation, Real Estate Purchase Clients and Bankruptcy Clients: If services are required
beyond the basic service covered by a flat fee, hourly rate charges will be added.
 
Scope of Engagement: We have been engaged to provide the following services:
 
I acknowledge receipt of the above information and agree to same.
 
Attorney:
Matter:
   
Client Signature:
Client Signature:
   
Cardholder Signature:
Please contact us for a break down of hourly rates for our attorneys.
   
   
 
   
 

 

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