Brazile Law Firm - North Carolina Residency Intake Form
Please complete this form as a preliminary review of your residency.  Once you have completed this form, we will review the information and follow up with a time for a more in-depth consultation.  The fee for an initial consultation is $150, and any fee collected will be applied to your services if you later retain our firm.

Please allow two business days for us to review this form and follow up.  
Sign in to Google to save your progress. Learn more
Full Name *
Please include your first name, middle initial, last name
Email Address *
Phone Number *
Date of Birth *
MM
/
DD
/
YYYY
What institution do you currently attend? *
When did you first begin at that institution? *
MM
/
DD
/
YYYY
What is your current permanent address? *
How long has this been your permanent address? *
Please list months and years, for example 2 years 11 months
What is your marital status? *
If married, in which state does your spouse permanently reside?
Leave blank if unmarried
Are you an active-duty U.S. military person, or are you the spouse/dependent of a member of the U.S. armed forces?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Brazile Law Firm, PLLC. Report Abuse
Google Forms