Client Intake Form
Newkirk Zwagerman Client Intake Form
Email address *
Name *
Email *
Address *
Phone number *
How did you find us? *
Age *
Race
Employer name *
Employer address *
How long employed *
Position *
Total # of employees *
Were you terminated? (If yes, what date?) *
Person's Involved (Names, Age, Race) *
Reasons you need an attorney (In Detail) *
Submit
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