Intake Form

Name: https://www.rgmelendezlaw.com/
Address: 470 3rd Ave, Suite 4, Chula Vista, CA, 91910, US
Telephone: (619) 420-5900

First name*

Last name*

Business Name (if applicable)

Birthday*

Month

Day

Year

Social Security Number*

Email*

Mobile Phone*

Multi-line address

Country/Region*

Address*

Address - line 2

City*

Zip / Postal code*

Job Title*

Employer*

Start of Employment*

Work Phone

Marital Status*

Dependents (Name & Age)

Have you resided in California for at least 2 years?*

Yes

No

Have you ever filed a bankruptcy before?*

Yes

No

How did you hear about us?*

Law Offices of Rick G Meléndez

470 3rd Ave, Suite 4, Chula Vista, CA 91910, USA

office.legalhelpers@gmail.com

(619) 420-5900

*All information displayed on the Law Offices of Rick G Meléndez website is informational and shall not be deemed as legal advice. If you’re currently dealing with an individual legal situation, you’re invited to contact our team through email or by phone. Until an attorney-client relationship has been established, we urge that you avoid sharing any confidential information.

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