Intake Form 1 2 3 InstructionsThe rules that govern lawyer conduct require that we determine whether a proposed engagement presents a "conflict of interest" before we accept a new client. This form will only take a moment of your time, and then you'll hear back from us by email (or phone call, if warranted) in a short time, typically by the end of our business day at the latest.Your Name* First Last Your Email* Enter Email Confirm Email Your Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Your Phone*Choose a Password*Certain of our services require access to secure areas of our website; we thus ask you to choose a password now for your later use should we ultimately accept your engagement. Enter Password Confirm Password Strength indicator For this engagement, will I be representing:*you alone?you and others?an existing business?a business being formed?Name of the business:*Type of Entity*Sole ProprietorshipPartnershipLimited Liability CompanyCorporationOtherWhich best describes the legal service you need:*I'm forming a new companyI'm buying or selling an existing businessI need help reviewing or drafting a contractI'm involved in a business disputeI want to enroll in your general counsel serviceI'm selling restricted securities and need a legal opinionOtherGeneral Counsel ServiceWho, besides you, owns this business?*Kindly include the full names of all individuals and entities. You might also describe how each co-owner is related to you, if that is the case. noneDescribe, generally, the nature of your business.*What industry do you compete in and what is your area of focus? Think "elevator speech" -- tell me that.NewCo ServiceWho, besides you, will be involved in the formation, funding, or operation of this business?*Kindly include the full names of all individuals and entities who, insofar as you know, may be involved in the formation, funding, or near-term operation of this business. NoneDescribe, generally, the nature of your business.*What industry do you compete in and what is your area of focus? Think "elevator speech" -- tell me that.M&A ServiceWho owns the business now?*Kindly include the full names of all individuals and entities. You might also describe how each co-owner is related to you, if that is the case. Who will own the business once the purchase and sale is completed?*Kindly include the full names of all individuals and entities. You might also describe how each co-owner is related to you, if that is the case. Contract ServiceDescribe the general nature of the contract.*Who are the parties to the contract?*Pre-Litigation CounselingDescribe the general nature of the dispute.Describe the nature of the dispute in very general terms. At this stage please do not provide any confidential information. The disclosure of such information may not be protected until we formally agree on the terms of engagement.Who are the parties involved?*Legal Opinion ServiceWhat is the name of the company whose securities you intend to sell?*What does the company use as its ticker symbol, if it has one?You may look up the ticker symbol on a number of websites, including, for example, Yahoo FinanceIdentify the owners who hold title to the securities being sold.*List each, separated by by a comma, and include yourself, assuming you are an owner. If the holder is an entity, please also include the type of entity and the jurisdiction in which it is organized. For example, Smith & Co., a Delaware corporation.Other ServicesIf other, please explain:*Describe in very general terms the project for which you seek to engage Stansell Law PLLC. At this stage please do not provide any confidential information. The disclosure of such information may not be protected until we formally agree on the terms of engagement.Others who have an interest in the matter:*List (i) everyone else besides you (both individuals and entities) who may be involved in the project and (ii) for each, indicate the nature of the involvement. For example: John Smith (co-founder) NoneIdentify any adversely interested parties:*If your matter involves a potential disagreement of some kind (regardless whether it will likely lead to litigation), please list each potentially adverse person (whether an individual or entity) and describe briefly that person's relationship to the matter.None Last ThingsHow did you hear about Stansell Law PLLCSearch EngineLinkedInAvvoTwitterReferralOtherWho referred you?I like to thank those who refer business to me. Can you identify who referred you? Which search engine?Please explain "other."Subscribe to Legal News & Insights?I occasionally distribute brief newsletters and alerts to clients about legal developments and other matters of potential interest. Do you want to be included? Yes, please subscribe.No thanks.CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.