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INITIAL REQUEST FOR LEGAL ASSISTANCE

INSTRUCTIONS

Before completing the application please note:

  1. No attorney/client relationship is created by submitting this application.
  2. If you need assistance in completing the form, please call us at (954) 361-3664.
  3. Paper forms are available as well.
  4. Please allow up to 24 hours for someone to contact you regarding your application.

APPLICATION

Complete This Section Only If Applying for Someone Else


PERSONAL INFORMATION

The information you provide is confidential.

CONTACT INFORMATION


ARREST INFORMATION


FINANCIAL INFORMATION


COMMENTS


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