Which of the following may we provide for you? Please check all that apply.

Create a Will

Modify an Existing Will

Appoint Power of Attorney (Individual to handle Financial Decisions such as Real Estate, Banking, etc.)

Create a Living Will (Advanced Directives for Healthcare Purposes)

Are you Married, Separated, Single, Divorced?

Married

Separated

Single

Divorced

How many dependents do you have?

0

1-3

4-6

7+

Do you have any of the following? Please check all that apply.

Real Estate (Owner Occupied and/or Rental)

Vehicles

Valuable Artwork

Jewelry

How soon would you like these services completed?

Within two weeks

Within one month

Within three months

Within six months

Is there any SPECIFIC INFORMATION you would like to provide prior to our phone call?

Email *

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