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Client Intake (Agency)

Is your Allstate R3001 Agreement in the name of your corporate entity or you individually? (Confirm using your monthly report.)

Your Name(Required)

First Last

Spouse Name

First Last

Primary Phone(Required)

Type

Primary Phone

Type

Secondary Phone

Type

Secondary Phone

Type

Home Address

Street Address Address Line 2 City State ZIP Code

If you are buying or selling in your individual name only and not the name of your corporate entity, you may skip this section.

Name of Organization(Required)

Type of Entity

State of Formation

Federal Tax Identification Number (FEIN)

Organization Address (if different)

Street Address Address Line 2 City State ZIP Code

Which address should be used for billing?

How did you hear about Wright Beamer?

Please specify

The Michigan Rules of Professional Conduct require us to question new clients before we represent them in order to ensure that there are no conflicts of interest.

Have you (or the organization) been involved in a legal dispute?

If yes, please specify

Have you (or the organization) been by represented by a Wright Beamer attorney?

(including of counsel attorney George Smrtka)

If yes, please specify

Would you like to receive our weekly email newsletters?

By submitting this form, you agree that you have reviewed the Wright Beamer Firm Policies and agree to our Privacy Policy.

Client Intake (Agency)

Client Intake (Agency)

Client Intake (Agency)

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