A “conflicts check” is a necessary step before a firm discusses confidential information with a potential client. Please know that sending this form does not create an attorney-client relationship and that the firm typically requires a retainer agreement to be executed before undertaking work.

Your full legal name: *

Address *

City

State *

Zip

Contact Email *

Contact Phone *

Full legal name of your entity

If your dispute involves a corporate entity or partnership operated by you.

FEI Number of your entity

(tax ID number for entity)

Fictitious name for your entity (aka dba)

Entity Address

City

State

Zip

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IMPORTANT: please provide the full legal names of each party with whom you have a dispute (i.e. adverse party)

Adverse Party *

Adverse Party Address *

City *

State *

Zip *

IMPORTANT: Are there any other persons or entities who are involved in this dispute? If so, please provide their full legal names here:

Security Code: *
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