Client Intake And Retainer Agreement

CLIENT INTAKE AND RETAINER AGREEMENT(1) Name: _______________________________________ (2) SS#: ____________________(3) Address: _________________________________________________________________ __________________________________________________________________(4) Phone: ( ) __________________ (5) Date of Birth: _____________________________(6) Spouse: ___________________ (7) Children: __________________________________(8) Employment: ______________________________________________________________(9) Employment History: _______________________________________________________ _________________________________________________________(10) Date of Arrest: ____________ (11) Arresting Authorities: _________________________(12) Charge (s): ________________________________________________________________(13) Bond Amount: __________ (14) Bonding Company: _____________________________(15) Preliminary Hearing Date/Court: ______________________________________________ (16) Arraignment Date/Court: ____________________________________________________(17) Trial Date/Court: ___________________________________________________________(18) Prior History/Probation and/or Parole Holds _____________________________________ _________________________________________________________________________(19) What do police or authorities accuse Defendant of doing (you may complete on back): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________(20)What is your version of events (you may complete on back): ________________________ <<<<<<<<<********>>>>>>>>>>>>> 2 __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ (21)Provide name, address, telephone number, and relationship of persons you specifically authorize my office to give updates on your case: (A) _________________________________________________________________ (B) _________________________________________________________________ (C) _________________________________________________________________