<p> Attorney-Client Privileged Information CONFIDENTIAL PROSPECTIVE CLIENT QUESTIONNAIRE</p><p>Your Personal Information: Date:______</p><p>Name:______(First) (Middle) (Last) (Maiden)</p><p>Home Address:______(Street/P.O. Box) (City)</p><p>(Coun ty) (State )</p><p>(Zip)</p><p>May we send your mail to your home address? Yes No If not, provide an alternate mailing address:______</p><p>Telephone: Home ______May we call you there? Yes No Work ______May we call you there? Yes No Cell ______May we call you there? Yes No Other numbers where you can be reached: ______</p><p>E-mail address: ______May we contact you there? Yes No Birth:______(Date: DD/MM/YY) (Place)</p><p>(Present Age)</p><p>Name of your employer: ______</p><p>Occupation: ______Hours worked:______</p><p>Length of employment: ______</p><p>How long have you lived: In Texas? ______In your county? ______</p><p>Confidential Prospective Client Questionnaire – Page 1 (Rev. 07/06) © Collaborative Law Institute of Texas, Inc. 2003 Personal Information of Your Spouse, Ex-Spouse or Other Party:</p><p>Name:______(First) (Middle) (Last) (Maiden)</p><p>Home Address:______(Street/P.O. Box) (City)</p><p>(County) (State) (Zip)</p><p>Telephone: Home ______; Work ______; Cell ______</p><p>Birth:______(Date: DD/MM/YY) (Place) (Present Age)</p><p>Name of other party’s employer: ______Length of employment: ______</p><p>Occupation: ______Hours worked:______Marriage (If divorce being considered):</p><p>Date and Place of Marriage:______(DD/MM/YY) (City, State) Date of Separation: ______(DD/MM/YY) Have you ever signed a pre-marital or post-marital agreement? ______Pre-Marital/Post-Marital Agreement Matters: </p><p>Date and Place of (Contemplated) Marriage: ______(DD/MM/YY) (City, State) ______Post-Decree Matters: </p><p>Date and Place of Decree:______(DD/MM/YY) (City, County, State) Cause Number of Case and Court (if known): ______Children (whether minors or not) Name (first,middle,last) Age Date of Birth Grade School (DD/MM/YY) Attending</p><p>Confidential Prospective Client Questionnaire – Page 2 (Rev. 07/06) © Collaborative Law Institute of Texas, Inc. 2003 ______</p><p>How did you hear about our firm? ______</p><p>Former Client ______Lawyer Referral ______Name Name Other ______</p><p>List any attorney consulted by you previously in this matter: ______</p><p>List any attorney consulted by the other party in this matter: ______</p><p>Confidential Prospective Client Questionnaire – Page 3 (Rev. 07/06) © Collaborative Law Institute of Texas, Inc. 2003</p>