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MARGARET GETTLE WASHBURN, P.C.
ATTORNEY AT LAW
4799 Sugarloaf Parkway
Building J
Lawrenceville, GA 30044
770-963-1105
770-963-2828 facsimile
NEW CLIENT INFORMATION SHEET
Welcome to our office!
Please complete this form. The information provided is strictly confidential and is to be
used only in connection with legal services that may be performed for you. Date:___________
NAME: _________________________________________________________________
DATE OF BIRTH:_____________________________________________________________
SOCIAL SECURITY NO.:______________________________________________________
RESIDENCE ADDRESS:_______________________________________________________
_______________________________________________________
MAILING ADDRESS: _______________________________________________________
_________________________________________________________
HOME PHONE:______________________________________________________________
PAGER:___________________________________ CELLULAR:______________________
EMAIL:___________________________________ EMAIL #2:________________________
EMPLOYER NAME AND ADDRESS:___________________________________________
_______________________________________________________________
_______________________________________________________________
WORK PHONE:_____________________________ FACSIMILE:_____________________
(______) Please check here if you need notification before receiving facsimile transmittals.
Name, Address, and Telephone Number of a Close Friend or Relative we can contact who will
always be able to reach you:_____________________________________________________
____________________________________________________________________________
REFERRED BY:______________________________________________________________
STATE BRIEFLY THE NATURE OF YOUR CASE:________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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A successful man is one who can lay a firm foundation with the bricks others have thrown at him. | David Brinkley