*IMPORTANT Before we begin, the Firm must determine whether   there is a conflict of
           interest with an existing client.  Therefore, you must provide your name, address and
           telephone number.  If there is a conflict, the Firm will be unable to give you any legal advice
           and you should seek the advice of other counsel.

           (* indicates a required field) 

* First Name
* Last Name
* Street/P.O.Box
Apt/Suite
* City
* State
* Zip Code
* Telephone
Facsimile
E-Mail

        Your area(s) of legal concern: Auto Accident Bankruptcy Child Support Custody Divorce Drunk Driving/DUI Landlord/Tenant Personal Injury Real Estate Restraining Orders Slip & Fall Traffic Tickets Wills and Trusts Workers Compensation (Other)

        How did you find Attorney Eger: Mailer/Postcard Newspaper Referred Web Search Yellow Book Yellow Pages (Other)

          If Referral or Other, please specify :

        Please explain your legal concern below:

Optional Information:

          Relationship Status:      Single    Married     Divorced  Widowed

          Children:     (Not Selected) 1 2 3 4 5 more than 5   # of Children?

           Child Support Services:     (Not Selected) No Yes Do you need child support services?

          Residency:    (Not selected) Own Rent Do you own or rent your home?

          Amount of Mortgage/Rent?

            US Citizen or     Other

          Employment:     Occupation 

          Annual Income? 

          Estate:      Do you have a Will/Trust or Estate Plan?  Yes   No

          Bankruptcy:    Have you ever filed for Bankruptcy?  Yes   No

          How much debt do you have now?