Please print out the following Client Information Sheet and mail it to us, or bring it in with you when you visit our office.
Client Information Sheet
TODAY'S DATE: ________________
CLIENT NAME: _______________________ SPOUSE: _________________
ADDRESS: _________________________________________________________
CITY: __________________ STATE: _________ ZIP CODE: _________
HOME PHONE NUMBER: ______________________
WORK PHONE NUMBER: ______________________ FAX: ________________
DATE OF BIRTH: __________________ SOCIAL SECURITY #:______________
ALTERNATE CONTACT PERSON: _______________________________________
ADDRESS: ____________________________________________________________
CITY: ______________________ STATE: _________ ZIP CODE: ___________
PHONE NUMBER: ________________
**I HEREBY AUTHORIZE HOEPER LAW OFFICES TO DISCUSS WITH AND DISCLOSE INFORMATION RELATING TO MY CASE TO MY ALTERNATE CONTACT PERSON. _____________________________(Sign If Authorizing)
YOUR EMPLOYER: _____________________________________________________
EMPLOYER ADDRESS: __________________________________________________
EMPLOYER PHONE: _______________________ SHIFT WORKED: _____________
PAID: WKLY: _____ LAST DATE PAID: __________________
BI-WKLY: _____ MONTHLY: _____
TYPE OF LEGAL SERVICE REQUESTED: __________________________________ ANY CHANGE IN THE INFORMATION ABOVE MUST BE REPORTED IMMEDIATELY TO OUR OFFICE AT (920)324-5050.
DID YOU LEARN OF OUR FIRM BY: NEWSPAPER AD _____ RADIO: WMRH _____ WRPN _____ WEBSITE_______
PHONE BOOK _____ WHAT PAGE? _____
REFERRAL _____ WHO REFERRED YOU: _____________
| Hoeper Law Offices | |
512 E. Main Street
Waupun, WI 53963
Telephone: 920-324-5050
Fax: 920-324-8866 | |
Hoeper Law Offices has locations in Waupun and Green Lake, Wisconsin and represents clients in Beaver Dam, Mayville, Lomira, Fond du Lac, Sheboygan, Ripon, West Bend, Montello, Oshkosh and other towns in Dodge County, Fond du Lac County, Green Lake County, Marquette County and the Fox River Valley.
