DCD : New Client Intake

Debt Collection : New Client Intake
Matter Type
T+M Email
Person Taking the Call*
Legal Insurance Provider*
Case #/Matter #/Eligibility ID*
The number from your legal insurance provider, or N/A if client is Self-Paying.
Urgency*
Bankruptcy Filed Before*
If yes, year filed:
T+M Email Name
Client First Name*
Client Last Name*
Phone Number*
Email Address*
Mailing Address*

Street Address

Street Address Line 2

City

Zip Code
State*
Arizona, Colorado, Iowa, Nebraska, New Mexico and Texas only.
Appointment
Calendly Call Date*

MonthDayYear
Any additional information that may be helpful.
Should be Empty:

Debt Collection : New Client Intake