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Potential Client Intake Form
Brief summary of the circumstances regarding why you need an attorney
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First Name
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Last Name
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Address
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City, State
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Phone Number
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Email
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Birth Date
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Please specify the following information for the collection agency who has been communicating with you. PLEASE USE SEPARATE FORMS FOR EACH COLLECTION AGENCY, IF MULTIPLE.
Name of Collection Agency:
First date you received any communication with the Collection Agency?
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DD
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How often you have been getting calls?
Have you disputed the debt?
Do you have the letters received from the debt collector?
Do you know what the debt is relating to?
In your opinion, what is the worst thing the debt collector or attorney did or said?
Description of how they have harmed you (emotionally or financially):
Please check all that apply to the above creditor only.
Has the debt collector or attorney communicated about the alleged debt in any of the following ways? (check boxes for:
They called my cell phone and left an automated message.
They called me before 8:00 am or after 9:00 pm.
They called me or sent me a letter after I told them I have an attorney.
They have been calling me at work.
They have spoken with or sent letters to other people about my debt.
They contacted me after I told them to stop.
They did not disclose they are recording our conversation.
Has the debt collector or attorney conducted themselves in any of the following ways?
They threatened violence or to damage my reputation.
They swore at me or used abusive language.
They telephoned me repeatedly over short periods of time.
They left me messages and did not give their business name or say they were debt collectors.
Has the debt collector or attorney done any of the following?
They lied to me.
They are asking me for money they are not entitled to.
They are claiming they are attorneys when they are not.
They say I committed a crime or that I could be arrested, that I committed fraud, or that they will garnish my wages, take my house, etc.
They have threatened to do things they really can’t do.
Has the debt collector or attorney done any of the following?
They are asking for “collection fees,” or other charges.
They asked for and accepted postdated checks from me.
They are threatening to repossess or attach my property.
They are sending me letters or post cards and these communications indicate they are debt collectors on the envelopes or postcards.
They sent me a letter and the envelope in came in looked like a credit card offer or something it wasn’t.
They have reported inaccurate and/or misleading information on my credit report.
If Currently in litigation please provide the following:
Case Name?
Case Status?
Name of Parties Involved?
Are you represented by an Attorney?
On the lines below, list the documents (papers) that you think may help us to understand any pending issues in your lawsuit?
Ideally, if things turn out precisely the way you want, what would the outcome be?
Knowing that there are no guarantees, what can you accept?
Are we the first attorneys you have consulted regarding this matter? If No – Why didn’t you hire their services?
Have you ever been represented by an attorney before for any reason? If Yes – Please state the circumstances and the year?
How did you learn of our office: A Friend / Yellow Pages / Bar Referral / Our Web Page / Former Client / An Attorney
Any other information that you think is important for us to know about you or your current situation:
Has the debt collector or attorney done any of the following? They are threatening to sued me / They did sue me / They sued me in a county that I did not live in a the time the suit was filed
If the above does not pertain to your circumstances, please explain in detail what your circumstances are and how we can help
PLEASE READ CAREFULLY
NOTICE: This office does not represent you with regard to the matters set forth by you herein in this information sheet or discussed during your consultation unless and until, both you and the Attorney execute a written Agreement for Representation and the agreed upon retainer fee is received by the Attorney. Please be advised, that any and all existing due dates, deadlines, statutory obligations and/or rights that may be related to any matters addressed above, will be solely your responsibility, until and unless we have expressly in writing agreed to represent your interest. At this point, our office does not agree to represent you. This includes not representing you with regard to the matter set forth by you on this information sheet, nor any other matters you may discuss with the Attorney during your consultation. If your legal problem(s) involve a potential lawsuit, it is important that you realize a lawsuit must be filed within a certain period of time called a Statute of Limitations. Therefore, the Attorney strongly urges you to immediately consult with another attorney to protect your rights. The Attorney’s decision not to represent you should not be taken by you as an expression regarding the merits of your case.
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41707 Winchester Road #201
Temecula, California 92590
(951) 293-4187
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Home
Our Firm
Credit Report Issues
Debt Collection
Labor Law
Recent Cases
Blog
Reviews
Contact
Posted on
March 3, 2018
Client v. Secure Capital Management, Inc.; Ace Cash Express, Inc.
Case Number:
3:16-cv-01215-BEN-JLB
Case Name:
Client v. Secure Capital Management, Inc.; Ace Cash Express, Inc.
Court:
Southern District of California
Date Filed:
05/19/2016
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