Wilks Law Intake Form

If you have questions on how to fill out this form, please let us know at Contact Us and we will be happy to help out. Or if you prefer, simply print this form and mail or fax it to us at

Law offices of Robert A. Wilks & Associates
P.O. Box 1013
Tustin, CA 92680

Fax: 714-838-5990

Debtor

Name
Title
Organization
Street address
Address  (cont.)
City
State/Province
Zip/Postal  code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Creditor

Name
Title  
Organization  

Amount of Claim


Date of last payment (if none, so state):

Bank Information

Name

Creditors Compositions

INDIVIDUAL
PARTNERSHIP
CORPORATION - Inc. In the State of:

Instructions to the Attorney

Submit Suit Requirments
Investigate and Advise
File Suit Immediately

Basis of Claim

Merchandise
Note
Service
Contract

Our Experience

Broken Promises
Partial Payments
Stopped Payments
NSF Checks
Dispute
Unable to Contact
Pleads Poverty

Enclosures (if mailing)

Statements
Invoice
Note(s)
NSF Checks
Contract
Suit Costs

Remarks


Forwarded By:

Name
Title
Organization
Street address
Address  (cont.)
City
State/Province
Zip/Postal  code
Country
Work Phone
FAX
E-mail
URL


Contact Us Phone (toll-free): 800-518-LAWS (5297) Fax: 714-838-5990