New Client Info

New Client Information Form.

Please provide the information requested below. Additionally, please read and acknowledge McDannold Law's privacy policy regarding client Social Security Numbers.

CLIENT INFORMATION

* Indicates required field

Last Name *

First Name *

Middle Name *

Maiden Name *

Sex *

Date of Birth *

City of Birth *

County of Birth *

State of Birth *

Street Address *

City *

County *

State *

Zip *

Social Security Number *

Driver License Number *

State Issued *

E-Mail Address *

Select All That Apply *

I authorize e-mail communication about my case. I authorize e-mail communication of general interest from McDannold Law. I authorize follow-up telephone calls regarding my case.

Home Phone *

Work Phone *

Cell Phone *

Place of Employment *

Job Title *

Address of Employment *

SPOUSE INFORMATION

Spouse's Full Name *

Spouse's Address *

Spouse's Maiden Name *

Spouse's Employer *

Spouse's Date of Birth *

Spouse's Phone *

FINANCIAL RESPONSIBILITY

EMERGENCY CONTACT INFORMATION

Person Financially Responsible *

Full Name of Responsible Person *

DOB of Responsible Person *

Address of Responsible Person *

Phone of Responsible Person *

SSN of Responsible Person *

DL Number of Responsible Person *

DL State of Issue *

Full Name of Emergency Contact *

Address of Emergency Contact *

Cell Phone of Emergency Contact *

Other Phone of Emergency Contact *

Purpose of Visit *

Have you consulted another attorney in this matter? *

Do you currently have a will, trust, or other Estate Planning document? *

Have you been denied Social Security benefits? *

Have you been denied Veterans benefits, or been rated incorrectly? *

How were you referred to McDannold Law? *

PRIVACY POLICY REGARDING CLIENT SOCIAL SECURITY NUMBERS

Social Security information will only be used in the event you hire the firm to represent you in your legal matter, and then only when necessary during the course of your case.

Social Security numbers are collected by the law firm from the client, and all clients provide such information to the firm in writing.

Social Security numbers are most often used to positively identify parties. Some uses may include initial service, in court orders, in required reports filed with the State of Florida, or to obtain retirement or other information from third parties. Most courts require the Social Security numbers of all parties.

All information received from a client is confidential. Numbers are not released from the firm unless authorized by the client or required in the course of representation as stated herein.

The employees of McDannold Law have access to this personal information.

Every step is taken to protect your privacy. This information is kept secure within the offices of the firm in file folders and file drawers until such time that the file information is archived. Client files will be shredded in accordance with the firm’s record retention policy after the time required by the Florida Bar to maintain such records has expired. Social Security numbers are also securely maintained in firm software programs, all of which are encrypted and/or password protected.

By clicking the "SUBMIT" button below, I acknowledge that I have read the above privacy information provided by McDannold Law regarding the use of my Social Security number.

Submit