Please provide the following information to assist Walters Law Group in setting up your file and conducting the required conflict check (* denotes required field):
Your Full Name:*
Name of Your Company or Business (if applicable):
Jurisdiction of Incorporation (State/Province/Country):
Names of all Directors:
Names of All Principles / Owners of Business:
Ultimate Beneficial Owner(s)*:
Your Title/Position:
Your Date of Birth:*
Mailing Address:*
Physical Address (if different from above):
Phone Numbers:*
Home:
Office:
Cell:
Fax:
Authorized Email Address (for official communications):*
Billing Email Address (if different from Authorized email):
Additional Email Addresses:
Website(s) / Domain Name(s):
Brief description of legal services sought:
List any adverse parties (if any):
How were you referred to our firm?:
*I affirm, under the penalties of perjury pursuant to the laws of the United States, that the above information is true and correct, and that any funds used to pay for attorneys fees were generated by lawful activity. I further adopt the typed name below as my electronic signature.
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