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Express Service™
Offices
Helping Make Things Right.

Express Service Form

Contact Info
Type of Matter:
*First Name: *Last Name:
MI: Maiden Name:
SSN: Date of Birth:
Street Address: City:
State: Zip:
Home #: Work # (include ext):
Cell/Pager #: Business / Employer Name:
Employer Street Address: City:
State: Zip:
*Email Address: Do you prefer contact by: Email US Mail
Marriage Date: Place of Marriage:
Separation Date:
Have you discussed this legal matter with another attorney? Yes No
Attorney Name:
Children Info
Children Name Date of Birth Mother's First & Last Name Father's First & Last Name
(Child 1)
(Child 2)
(Child 3)
(Child 4)
Opposing Party Information
First Name: Last Name:
MI: Maiden Name:
SSN: Date of Birth:
Street Address: City:
State: Zip:
Home #: Work # (include ext):
Cell/Pager #: Business / Employer Name:
Employer Street Address: City:
State: Zip:

To qualify for the $100.00 credit please select the most appropriate box below to each of the following 4 questions.

1. How were you first introduced to Lutz Law Offices, P.S.?
Internet Search
Family / Friend
Attorney Referral 		Phonebook Ad
Company Sign
Other
2. What was the most important single factor in your selection of Lutz Law Offices, P.S.?
Firm Reputation
Attorneys
Location
Family Law Practice
Website
 Military Family Focus
Family / Friend
Attorney Referral
Other
3. What impact did our website, www.lutzlaw.com, have on your decision to contact us?
High Impact
Moderate Impact
Low Impact
Never Visisted Website (before making my decision)
4. What www.lutzlaw.com website "page" was of greatest value to you?
Home Page
Attorney Bio
Video
Testimonial
 Express Service
Military Divorce
Other
Select Attorney
Please Select an Attorney / Office Location nearest you.
Requested Appointment Date:
Requested Appointment Time:
How would you like to be contacted?

Special Note:All 3 of the questions below must be checked "Yes" for your "Express Service" request to be processed without delay.

I agree to pay for the entire time expended during the initial consultation at the attorney's regularly hourly rate if I retain the attorney for additional services. Yes
I am aware that this form does not constitute a fee agreement for services beyond the initial consultation. Yes
I am aware that I am not a client unless the attorney and I sign a fee agreement for additional legal services. Yes