Name:

Address:

Phone Number:

Email Address:

Best way to contact you: Email Phone

Style of Case:

v.
.

Case Number:
(if available)

Your Attorney's Name:

Can we contact your trial attorney? Yes No

Opposing Counsel's Name:

Date of Order/Judgment:

Judge's Name:

Was a court reporter present at your hearing? Yes No

Referred By:

Type of Appeal: (i.e., family law, real estate, corporate)