<%' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit.

On Error Resume Next
Session("FP_OldCodePage") = Session.CodePage
Session("FP_OldLCID") = Session.LCID
Session.CodePage = 1252
Err.Clear

strErrorUrl = ""

If Request.ServerVariables("REQUEST_METHOD") = "POST" Then
If Request.Form("VTI-GROUP") = "0" Then
	Err.Clear

	Set fp_conn =  Server.CreateObject("ADODB.Connection")
	FP_DumpError strErrorUrl, "Cannot create connection"

	Set fp_rs = Server.CreateObject("ADODB.Recordset")
	FP_DumpError strErrorUrl, "Cannot create record set"

	fp_conn.Open Application("CPKLaw2.0_ConnectionString")
	FP_DumpError strErrorUrl, "Cannot open database"

	fp_rs.Open """Client Intake Profile""", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable
	FP_DumpError strErrorUrl, "Cannot open record set"

	fp_rs.AddNew
	FP_DumpError strErrorUrl, "Cannot add new record set to the database"
	Dim arFormFields0(51)
	Dim arFormDBFields0(51)
	Dim arFormValues0(51)

	arFormFields0(0) = "CaseTitle"
	arFormDBFields0(0) = "In Re:"
	arFormValues0(0) = Request("CaseTitle")
	arFormFields0(1) = "CzipCode"
	arFormDBFields0(1) = "Client's Zip Code"
	arFormValues0(1) = Request("CzipCode")
	arFormFields0(2) = "OppCnslCity"
	arFormDBFields0(2) = "Opposing Counsel City"
	arFormValues0(2) = Request("OppCnslCity")
	arFormFields0(3) = "OppCnslName"
	arFormDBFields0(3) = "Opposing Counsel's Name"
	arFormValues0(3) = Request("OppCnslName")
	arFormFields0(4) = "CircuitCourtCounty"
	arFormDBFields0(4) = "Court County"
	arFormValues0(4) = Request("CircuitCourtCounty")
	arFormFields0(5) = "CStreeAddress"
	arFormDBFields0(5) = "Client's street address"
	arFormValues0(5) = Request("CStreeAddress")
	arFormFields0(6) = "PartiesCounty"
	arFormDBFields0(6) = "Party's County of Residence"
	arFormValues0(6) = Request("PartiesCounty")
	arFormFields0(7) = "ClientsDebts"
	arFormDBFields0(7) = "Client's Debts"
	arFormValues0(7) = Request("ClientsDebts")
	arFormFields0(8) = "ClientsGoals"
	arFormDBFields0(8) = "What is the client's desired outcome in litigation?"
	arFormValues0(8) = Request("ClientsGoals")
	arFormFields0(9) = "Defendant"
	arFormDBFields0(9) = "Defendant"
	arFormValues0(9) = Request("Defendant")
	arFormFields0(10) = "ClientsOccupation"
	arFormDBFields0(10) = "Client's Occupation"
	arFormValues0(10) = Request("ClientsOccupation")
	arFormFields0(11) = "ClientsPager"
	arFormDBFields0(11) = "Client's Pager"
	arFormValues0(11) = Request("ClientsPager")
	arFormFields0(12) = "ClientsEmployerAddress"
	arFormDBFields0(12) = "Client's employer's address"
	arFormValues0(12) = Request("ClientsEmployerAddress")
	arFormFields0(13) = "CourtPhoneNumber"
	arFormDBFields0(13) = "Court phone number"
	arFormValues0(13) = Request("CourtPhoneNumber")
	arFormFields0(14) = "CourtStreetAddress"
	arFormDBFields0(14) = "Court street address"
	arFormValues0(14) = Request("CourtStreetAddress")
	arFormFields0(15) = "CourtZipCode"
	arFormDBFields0(15) = "Court zip code"
	arFormValues0(15) = Request("CourtZipCode")
	arFormFields0(16) = "subject"
	arFormDBFields0(16) = "subject"
	arFormValues0(16) = Request("subject")
	arFormFields0(17) = "CourtCaseNumber"
	arFormDBFields0(17) = "Court Case Number"
	arFormValues0(17) = Request("CourtCaseNumber")
	arFormFields0(18) = "ClientsMobile"
	arFormDBFields0(18) = "Client's Mobile Phone"
	arFormValues0(18) = Request("ClientsMobile")
	arFormFields0(19) = "ClientEmployerZipCode"
	arFormDBFields0(19) = "Client's Employer's Zip Code"
	arFormValues0(19) = Request("ClientEmployerZipCode")
	arFormFields0(20) = "ClientsDriversNumber"
	arFormDBFields0(20) = "Client's Driver's License Number"
	arFormValues0(20) = Request("ClientsDriversNumber")
	arFormFields0(21) = "ClientsBirthDate"
	arFormDBFields0(21) = "Client's date of birth"
	arFormValues0(21) = Request("ClientsBirthDate")
	arFormFields0(22) = "ClientsWorkPhone"
	arFormDBFields0(22) = "Client's work phone"
	arFormValues0(22) = Request("ClientsWorkPhone")
	arFormFields0(23) = "ClientsAssets"
	arFormDBFields0(23) = "Client's Assets"
	arFormValues0(23) = Request("ClientsAssets")
	arFormFields0(24) = "AdverseState"
	arFormDBFields0(24) = "Adverse Party state"
	arFormValues0(24) = Request("AdverseState")
	arFormFields0(25) = "AdverseFname"
	arFormDBFields0(25) = "Adverse Party Name"
	arFormValues0(25) = Request("AdverseFname")
	arFormFields0(26) = "PartiesCurrentResidence"
	arFormDBFields0(26) = "Party's Place of Residence"
	arFormValues0(26) = Request("PartiesCurrentResidence")
	arFormFields0(27) = "ClientEmployerState"
	arFormDBFields0(27) = "Client's Employer's State"
	arFormValues0(27) = Request("ClientEmployerState")
	arFormFields0(28) = "OppCnslPhone"
	arFormDBFields0(28) = "Opposing Counsel's Phone Number"
	arFormValues0(28) = Request("OppCnslPhone")
	arFormFields0(29) = "CourtCity"
	arFormDBFields0(29) = "Court city"
	arFormValues0(29) = Request("CourtCity")
	arFormFields0(30) = "ClientFax"
	arFormDBFields0(30) = "Client's Fax"
	arFormValues0(30) = Request("ClientFax")
	arFormFields0(31) = "SocialSecNumber"
	arFormDBFields0(31) = "Client's Social Security Number"
	arFormValues0(31) = Request("SocialSecNumber")
	arFormFields0(32) = "ClientEmployerCity"
	arFormDBFields0(32) = "Client's Employer's City"
	arFormValues0(32) = Request("ClientEmployerCity")
	arFormFields0(33) = "MonthlyMortgage"
	arFormDBFields0(33) = "Amount of Monthly Mortgage Payment"
	arFormValues0(33) = Request("MonthlyMortgage")
	arFormFields0(34) = "OppCnslFax"
	arFormDBFields0(34) = "Opposing Counsel's Fax"
	arFormValues0(34) = Request("OppCnslFax")
	arFormFields0(35) = "ClientsHomePhone"
	arFormDBFields0(35) = "Client's home phone"
	arFormValues0(35) = Request("ClientsHomePhone")
	arFormFields0(36) = "AdverseMailingAddress"
	arFormDBFields0(36) = "Adverse Party's mailing address"
	arFormValues0(36) = Request("AdverseMailingAddress")
	arFormFields0(37) = "AdverseStreetAddress"
	arFormDBFields0(37) = "Adverse Party street"
	arFormValues0(37) = Request("AdverseStreetAddress")
	arFormFields0(38) = "Ccity"
	arFormDBFields0(38) = "Client's City"
	arFormValues0(38) = Request("Ccity")
	arFormFields0(39) = "OppCnslStreet"
	arFormDBFields0(39) = "Opposing Counsel's Address"
	arFormValues0(39) = Request("OppCnslStreet")
	arFormFields0(40) = "Gender1"
	arFormDBFields0(40) = "Client's sex1"
	arFormValues0(40) = Request("Gender1")
	arFormFields0(41) = "CPoBox"
	arFormDBFields0(41) = "PO BOX"
	arFormValues0(41) = Request("CPoBox")
	arFormFields0(42) = "CourtState"
	arFormDBFields0(42) = "Court state"
	arFormValues0(42) = Request("CourtState")
	arFormFields0(43) = "Gender2"
	arFormDBFields0(43) = "Client's sex2"
	arFormValues0(43) = Request("Gender2")
	arFormFields0(44) = "OppCnslState"
	arFormDBFields0(44) = "Opposing Counsel State"
	arFormValues0(44) = Request("OppCnslState")
	arFormFields0(45) = "JudgeAssigned"
	arFormDBFields0(45) = "Judge Assigned to the Case"
	arFormValues0(45) = Request("JudgeAssigned")
	arFormFields0(46) = "OppCnslZip"
	arFormDBFields0(46) = "Opposing Counsel Zip"
	arFormValues0(46) = Request("OppCnslZip")
	arFormFields0(47) = "Cstate"
	arFormDBFields0(47) = "Client's State"
	arFormValues0(47) = Request("Cstate")
	arFormFields0(48) = "AdverseZipCode"
	arFormDBFields0(48) = "Adverse Party zip code"
	arFormValues0(48) = Request("AdverseZipCode")
	arFormFields0(49) = "Plaintiff"
	arFormDBFields0(49) = "Plaintiff"
	arFormValues0(49) = Request("Plaintiff")
	arFormFields0(50) = "ClientsEmail"
	arFormDBFields0(50) = "Client's e-mail"
	arFormValues0(50) = Request("ClientsEmail")

	FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0


	fp_rs.Update
	FP_DumpError strErrorUrl, "Cannot update the database"

	fp_rs.Close
	fp_conn.Close

	FP_FormConfirmation "text/html; charset=windows-1252",_
						"Form Confirmation",_
						"Thank you for submitting the following information:",_
						"Client%20Intake%20Profile.htm",_
						"Return to the form."

End If
End If

Session.CodePage = Session("FP_OldCodePage")
Session.LCID = Session("FP_OldLCID")

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<meta name="VI60_DTCScriptingPlatform" content="Server (ASP)">
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height=83 src="Client%20Intake%20Profile_files/image003.jpg" v:shapes="_x0000_s1026"></span><![endif]><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
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		<p>&nbsp;&nbsp;&nbsp; </p>
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		<p><b><u><font size="2">30445 Northwester Highway, Suite 230, Farmington 
		Hills, MI 48334</font>/</u><font size="2"><u>248-737-8410 
    phone/1-866-728-4718 fax, </u>
		<a href="mailto:christopherpkohler@ameritech.net">
		christopherkohler@kohlerlaw.net</a></font></b></p>
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<span lang="en-US" style="color: white; font-style: italic; font-weight: bold; language: en-US; mso-ansi-language: en-US">
&quot;Your Michigan Divorce Lawyers!&quot;</span><span lang="en-US" style="language: en-US"><o:p></o:p></span></p>
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		<p align="center">
		<!--webbot bot="Navigation" S-Orientation="horizontal" S-Rendering="graphics" S-Theme="deepblue" S-Type="top" B-Include-Home="TRUE" B-Include-Up="FALSE" startspan --><!--webbot bot="Navigation" i-checksum="0" endspan --></p>
		<p>&nbsp;</p>
		<table border="0" width="58%" background="begin%20a%20case_files/image001.gif">
			<tr>
				<td><b><font face="verdana" color="#FFFFFF">Initial Client 
				Intake...</font></b></td>
			</tr>
		</table>
		<p>
<font face="verdana" size="2"><b>Please take the time to complete this form in its entirety.&nbsp; If the 
particular question asked doesn't apply to you, then simply enter &quot;not 
applicable&quot;.&nbsp; Also, you must complete this form in one sitting.&nbsp; 
Otherwise, the form will reset, and you will have to begin again.&nbsp; Some of 
the information requested here you have already provided, either during our 
initial office visit, or in other parts of the form.&nbsp; I need you to provide 
the information again nonetheless.&nbsp; I apologize for the redundancy, but you 
are still saving time and money by giving it to me over the internet.&nbsp; 
Also, I need you to be as descriptive as possible.&nbsp; At this stage there is 
no such thing as too much information.&nbsp; Dates, specific events, and other 
witnesses to said events are especially helpful. &nbsp; As 
always, should you have any questions, comments or concerns, please don't 
hesitate to contact me.&nbsp; Office number:&nbsp; 248-737-8410.</b></font></p>
		<p>&nbsp;</p>
		<!--webbot BOT="GeneratedScript" PREVIEW=" " startspan --><script Language="JavaScript" Type="text/javascript"><!--
function FrontPage_Form1_Validator(theForm)
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  if (theForm.SocialSecNumber.value.length < 9)
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    alert("Please enter at least 9 characters in the \"Field2\" field.");
    theForm.SocialSecNumber.focus();
    return (false);
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  if (theForm.SocialSecNumber.value.length > 9)
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    alert("Please enter at most 9 characters in the \"Field2\" field.");
    theForm.SocialSecNumber.focus();
    return (false);
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    theForm.Gender2.focus();
    return (false);
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    alert("Please enter at least 3 characters in the \"Field6\" field.");
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    alert("Please enter at most 50 characters in the \"Field9\" field.");
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    return (false);
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    alert("Please enter at most 50 characters in the \"Plaintiff\" field.");
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  if (theForm.PartiesCurrentResidence.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field23\" field.");
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    alert("Please enter at most 50 characters in the \"Field24\" field.");
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  if (theForm.MonthlyMortgage.value.length > 19)
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    alert("Please enter at most 19 characters in the \"Field25\" field.");
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  if (theForm.ClientsDriversNumber.value.length > 50)
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  if (theForm.ClientsHomePhone.value.length > 50)
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  if (theForm.ClientsWorkPhone.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field32\" field.");
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  if (theForm.ClientsPager.value.length > 10)
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    alert("Please enter at most 10 characters in the \"Field33\" field.");
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    theForm.ClientsPager.focus();
    return (false);
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  if (theForm.ClientsMobile.value.length > 10)
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    alert("Please enter at most 10 characters in the \"Field34\" field.");
    theForm.ClientsMobile.focus();
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    alert("Please enter only digit characters in the \"Field34\" field.");
    theForm.ClientsMobile.focus();
    return (false);
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  if (theForm.ClientFax.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field35\" field.");
    theForm.ClientFax.focus();
    return (false);
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  if (theForm.ClientsEmail.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field36\" field.");
    theForm.ClientsEmail.focus();
    return (false);
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  if (theForm.ClientsOccupation.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field37\" field.");
    theForm.ClientsOccupation.focus();
    return (false);
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  if (theForm.ClientsEmployerAddress.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field38\" field.");
    theForm.ClientsEmployerAddress.focus();
    return (false);
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  if (theForm.ClientEmployerCity.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field39\" field.");
    theForm.ClientEmployerCity.focus();
    return (false);
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  if (theForm.ClientEmployerState.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field40\" field.");
    theForm.ClientEmployerState.focus();
    return (false);
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  if (theForm.ClientEmployerZipCode.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field41\" field.");
    theForm.ClientEmployerZipCode.focus();
    return (false);
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  if (theForm.OppCnslName.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field44\" field.");
    theForm.OppCnslName.focus();
    return (false);
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  if (theForm.OppCnslCity.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field46\" field.");
    theForm.OppCnslCity.focus();
    return (false);
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  if (theForm.OppCnslState.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field47\" field.");
    theForm.OppCnslState.focus();
    return (false);
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  if (theForm.OppCnslZip.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field48\" field.");
    theForm.OppCnslZip.focus();
    return (false);
  }

  if (theForm.OppCnslPhone.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field49\" field.");
    theForm.OppCnslPhone.focus();
    return (false);
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  if (theForm.OppCnslFax.value.length > 50)
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    alert("Please enter at most 50 characters in the \"Field50\" field.");
    theForm.OppCnslFax.focus();
    return (false);
  }

  if (theForm.JudgeAssigned.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"Field51\" field.");
    theForm.JudgeAssigned.focus();
    return (false);
  }

  if (theForm.CourtCaseNumber.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"Field52\" field.");
    theForm.CourtCaseNumber.focus();
    return (false);
  }

  if (theForm.CourtPhoneNumber.value.length > 10)
  {
    alert("Please enter at most 10 characters in the \"Field53\" field.");
    theForm.CourtPhoneNumber.focus();
    return (false);
  }

  var checkOK = "0123456789-";
  var checkStr = theForm.CourtPhoneNumber.value;
  var allValid = true;
  var validGroups = true;
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  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
    allNum += ch;
  }
  if (!allValid)
  {
    alert("Please enter only digit characters in the \"Field53\" field.");
    theForm.CourtPhoneNumber.focus();
    return (false);
  }

  if (theForm.subject.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"subject\" field.");
    theForm.subject.focus();
    return (false);
  }

  if (theForm.CourtStreetAddress.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"Field59\" field.");
    theForm.CourtStreetAddress.focus();
    return (false);
  }

  if (theForm.CourtState.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"Field60\" field.");
    theForm.CourtState.focus();
    return (false);
  }

  if (theForm.CourtZipCode.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"Field61\" field.");
    theForm.CourtZipCode.focus();
    return (false);
  }

  if (theForm.CourtCity.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"Field62\" field.");
    theForm.CourtCity.focus();
    return (false);
  }

  if (theForm.CircuitCourtCounty.value.length > 50)
  {
    alert("Please enter at most 50 characters in the \"Field63\" field.");
    theForm.CircuitCourtCounty.focus();
    return (false);
  }
  return (true);
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//--></script><!--webbot BOT="GeneratedScript" endspan --><form method="POST" name="FrontPage_Form1" action="_vti_bin/shtml.dll/Client%20Intake%20Profile.htm" onsubmit="return FrontPage_Form1_Validator(this)" language="JavaScript" webbot-action="--WEBBOT-SELF--">
			<!--webbot bot="SaveDatabase" SuggestedExt="asp" S-DataConnection="CPKLaw2.0" S-RecordSource="Client Intake Profile" U-ASP-Include-Url="_fpclass/fpdbform.inc" startspan S-Form-Fields="CaseTitle CzipCode OppCnslCity OppCnslName CircuitCourtCounty CStreeAddress PartiesCounty ClientsDebts ClientsGoals Defendant ClientsOccupation ClientsPager ClientsEmployerAddress CourtPhoneNumber CourtStreetAddress CourtZipCode subject CourtCaseNumber ClientsMobile ClientEmployerZipCode ClientsDriversNumber ClientsBirthDate ClientsWorkPhone ClientsAssets AdverseState AdverseFname PartiesCurrentResidence ClientEmployerState OppCnslPhone CourtCity ClientFax SocialSecNumber ClientEmployerCity MonthlyMortgage OppCnslFax ClientsHomePhone AdverseMailingAddress AdverseStreetAddress Ccity OppCnslStreet Gender1 CPoBox CourtState Gender2 OppCnslState JudgeAssigned OppCnslZip Cstate AdverseZipCode Plaintiff ClientsEmail" S-Form-DBFields="In\ Re: Client's\ Zip\ Code Opposing\ Counsel\ City Opposing\ Counsel's\ Name Court\ County Client's\ street\ address Party's\ County\ of\ Residence Client's\ Debts What\ is\ the\ client's\ desired\ outcome\ in\ litigation? Defendant Client's\ Occupation Client's\ Pager Client's\ employer's\ address Court\ phone\ number Court\ street\ address Court\ zip\ code subject Court\ Case\ Number Client's\ Mobile\ Phone Client's\ Employer's\ Zip\ Code Client's\ Driver's\ License\ Number Client's\ date\ of\ birth Client's\ work\ phone Client's\ Assets Adverse\ Party\ state Adverse\ Party\ Name Party's\ Place\ of\ Residence Client's\ Employer's\ State Opposing\ Counsel's\ Phone\ Number Court\ city Client's\ Fax Client's\ Social\ Security\ Number Client's\ Employer's\ City Amount\ of\ Monthly\ Mortgage\ Payment Opposing\ Counsel's\ Fax Client's\ home\ phone Adverse\ Party's\ mailing\ address Adverse\ Party\ street Client's\ City Opposing\ Counsel's\ Address Client's\ sex1 PO\ BOX Court\ state Client's\ sex2 Opposing\ Counsel\ State Judge\ Assigned\ to\ the\ Case Opposing\ Counsel\ Zip Client's\ State Adverse\ Party\ zip\ code Plaintiff Client's\ e-mail" --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--#include file="_fpclass/fpdbform.inc"--><!--webbot bot="SaveDatabase" endspan i-checksum="40548" -->

<p><b><font face="verdana" size="2">What is your</font></b><font face="verdana" size="2"><b> Social Security Number?&nbsp;
<i>click here to review our privacy policy</i>.<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field2" s-data-type="Number" s-number-separators=",." b-value-required="TRUE" i-minimum-length="9" i-maximum-length="9" --><input name="SocialSecNumber" size="50" value="" maxlength="9" tabindex="1"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Please indicate your gender as &quot;he&quot; or &quot;she&quot;<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field5" s-data-type="String" b-value-required="TRUE" i-minimum-length="2" i-maximum-length="3" --><input name="Gender1" size="50" value="" maxlength="3" tabindex="2"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Please indicate your gender as &quot;his&quot; or &quot;her&quot;<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field6" s-data-type="String" b-value-required="TRUE" i-minimum-length="3" i-maximum-length="3" --><input name="Gender2" size="50" value="" maxlength="3" tabindex="3"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your first name?<br>
&nbsp;</b></font><font face="verdana"><b><input name="CFirstName" size="50" value="" maxlength="50" tabindex="4"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is your last name?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field8" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CLastName" size="50" value="" maxlength="50" tabindex="5"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">Please indicate a P.O. Box if you have one.</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field9" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CPoBox" size="50" value="" maxlength="50" tabindex="6"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your street address?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field10" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CStreeAddress" size="50" value="" maxlength="50" tabindex="7"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What city do you live in?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field11" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="Ccity" size="50" value="" maxlength="50" tabindex="8"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What state do you live in?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field12" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="Cstate" size="50" value="" maxlength="50" tabindex="9"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is your 5 digit zip code?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field13" s-data-type="Integer" b-value-required="False" i-maximum-length="10" --><input name="CzipCode" size="10" value="0" maxlength="10" tabindex="10"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Please indicate who, or who will be the Plaintiff and/or the Defendant 
in your action.</b></font></p>
<p><font face="verdana" size="2"><b>Who will be the Plaintiff?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Plaintiff" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="Plaintiff" size="50" value="" maxlength="50" tabindex="11"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Who will be the Defendant?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Defendant" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="Defendant" size="50" value="" maxlength="50" tabindex="12"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Please indicate what the title of your case is or will be, i.e., Kramer 
vs. Kramer, or Jones vs. Jones.<br>
&nbsp;</b></font><font face="verdana"><b><textarea rows="1" name="CaseTitle" cols="64" tabindex="13"></textarea></b></font></p>
<p><font face="verdana" size="2"><b>What is the Name of the Adverse Party?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field19" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="AdverseFname" size="50" value="" maxlength="50" tabindex="14"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is the street address of the Adverse 
Party?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field20" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="AdverseStreetAddress" size="50" value="" maxlength="50" tabindex="15"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What state does the adverse party live in?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field21" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="AdverseState" size="50" value="" maxlength="50" tabindex="16"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is the adverse party's zip code?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field22" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="AdverseZipCode" size="50" value="" maxlength="50" tabindex="17"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">If you and the Adverse Party live together, 
or have a residence in common, please write</font></b></p>
			<p><b><font face="verdana" size="2">the address here.</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field23" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="PartiesCurrentResidence" size="50" value="" maxlength="50" tabindex="18"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What county do you and the adverse party 
live in?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field24" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="PartiesCounty" size="50" value="" maxlength="50" tabindex="19"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>How much is your monthly mortgage?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field25" s-data-type="String" b-value-required="False" i-maximum-length="19" --><input name="MonthlyMortgage" size="19" value="" maxlength="19" tabindex="20"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">Please list your assets, and their 
approximate value.</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><textarea rows="10" name="ClientsAssets" cols="64" tabindex="21"></textarea></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">Please list your debts/liabilities and the 
approximate amount owed for each.</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><textarea rows="10" name="ClientsDebts" cols="64" tabindex="22"></textarea></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What are your goals and objectives for your 
case?<br>
&nbsp;</b></font><font face="verdana"><b><textarea rows="10" name="ClientsGoals" cols="64" tabindex="23"></textarea></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your date of birth?<br>
&nbsp;</b></font><font face="verdana"><b><input name="ClientsBirthDate" size="19" value="mm/dd/year" tabindex="24"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is your </font></b>
<font face="verdana" size="2"><b>Driver's License Number?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field30" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientsDriversNumber" size="50" value="" maxlength="50" tabindex="25"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your home phone?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field31" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientsHomePhone" size="50" value="" maxlength="50" tabindex="26"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your work phone?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field32" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientsWorkPhone" size="50" value="" maxlength="50" tabindex="27"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your Pager number?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field33" s-data-type="Integer" b-value-required="False" i-maximum-length="10" --><input name="ClientsPager" size="50" maxlength="10" tabindex="28"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your cell phone number?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field34" s-data-type="Integer" b-value-required="False" i-maximum-length="10" --><input name="ClientsMobile" size="50" maxlength="10" tabindex="29"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is your fax number if you have one?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field35" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientFax" size="50" value="" maxlength="50" tabindex="30"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is your e-mail address?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field36" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientsEmail" size="50" value="" maxlength="50" tabindex="31"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is your occupation?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field37" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientsOccupation" size="50" value="" maxlength="50" tabindex="32"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your employer's street address?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field38" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientsEmployerAddress" size="50" value="" maxlength="50" tabindex="33"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is your employer's city?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field39" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientEmployerCity" size="50" value="" maxlength="50" tabindex="34"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What state is your employer in?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field40" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientEmployerState" size="50" value="" maxlength="50" tabindex="35"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><b><font face="verdana" size="2">What is your employer's zip code?</font></b><font face="verdana" size="2"><b><br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field41" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="ClientEmployerZipCode" size="50" value="" maxlength="50" tabindex="36"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What is the adverse party's mailing address?<br>
&nbsp;</b></font><font face="verdana"><b><textarea rows="1" name="AdverseMailingAddress" cols="64" tabindex="37"></textarea></b></font></p>
<p><font face="Verdana" size="4"><b>If there already is another attorney on the other side, then complete the 
following information.&nbsp; Otherwise, I will get it eventually.<br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Opposing Counsel's Name<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field44" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="OppCnslName" size="50" value="" maxlength="50" tabindex="38"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Opposing Counsel's Street Address<br>
&nbsp;</b></font><font face="verdana"><b><textarea rows="1" name="OppCnslStreet" cols="42" tabindex="39"></textarea></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Opposing Counsel City<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field46" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="OppCnslCity" size="50" value="" maxlength="50" tabindex="40"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Opposing Counsel State<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field47" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="OppCnslState" size="50" value="" maxlength="50" tabindex="41"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Opposing Counsel Zip<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field48" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="OppCnslZip" size="50" value="" maxlength="50" tabindex="42"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Opposing Counsel's Phone Number<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field49" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="OppCnslPhone" size="50" value="" maxlength="50" tabindex="43"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Opposing Counsel's Fax<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field50" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="OppCnslFax" size="50" value="" maxlength="50" tabindex="44"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Judge Assigned to the Case<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field51" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="JudgeAssigned" size="50" value="" maxlength="50" tabindex="45"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Court Case Number<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field52" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CourtCaseNumber" size="50" value="" maxlength="50" tabindex="46"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Court phone number<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field53" s-data-type="Integer" b-value-required="False" i-maximum-length="10" --><input name="CourtPhoneNumber" size="21" value="0" maxlength="10" tabindex="47"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>subject&nbsp; (Please enter your first and last name again here)<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="subject" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="subject" size="50" value="" maxlength="50" tabindex="48"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Court street address<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field59" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CourtStreetAddress" size="50" value="" maxlength="50" tabindex="49"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Court state<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field60" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CourtState" size="50" value="" maxlength="50" tabindex="50"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Court zip code<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field61" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CourtZipCode" size="50" value="" maxlength="50" tabindex="51"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>Court city<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field62" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CourtCity" size="50" value="" maxlength="50" tabindex="52"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
<p><font face="verdana" size="2"><b>What county is the Circuit Court in where the action is pending or will be 
pending?<br>
&nbsp;</b></font><font face="verdana"><b><!--webbot bot="Validation" s-display-name="Field63" s-data-type="String" b-value-required="False" i-maximum-length="50" --><input name="CircuitCourtCounty" size="50" value="" maxlength="50" tabindex="53"></b></font><font face="verdana" size="2"><b><br>
</b></font>
</p>
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