New Clients - Loose Law Group AZ

Your Contact Information

First Name*

Last Name*

Last 4 of SSN*

Birth Year

Email Address*

Address*

City*

State*

Zip*

Cell Phone*

Home Phone

Work Phone

Preferred Method of Contact

Do you have a spouse or domestic partner?

Are you legally married?

Your Spouse or Partner

First Name

Last Name

Last 4 of SSN

Birth Year

Email Address

Cell Phone

Home Phone

Work Phone

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Employer

Your Request

Employer

Are you on a Legal Plan?*

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Legal Plan

Membership Number

Case Number

Please describe the nature of your legal matter

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Please tell us who referred you to our firm (or how you found us)

Yes, I understand submitting this form does not create an attorney-client relationship. By submitting, I am consenting to Loose Law Group, P.C. contacting me.

Welcome to Loose Law Group

Your Contact Information

Your Spouse or Partner

Your Request

Scottsdale

Tucson

Paradise Valley

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