ADMINISTRATIVE LAW CLIENT WORKSHEET

THANK YOU FOR YOUR CONSIDERATION OF OUR LEGAL SERVICES. FIRST, MAY WE REQUEST THE FOLLOWING INFORMATION. PLEASE TYPE IN ALL APPLICABLE BLANK AREAS AND CLICK SEND AT THE COMPLETION OF PAGE.

HOW DID YOU HEAR ABOUT US?

 

ARE YOU CALLING ON YOUR OWN BEHALF 
OR FOR SOMEONE ELSE? 

WHAT TYPE OF ISSUE OR CLAIM CAN WE HELP YOU WITH? ("x" after category)

U.S. COAST GUARD ; 

CREATION OF CONTRACT ; 

BUSINESS CLAIMS OR LITIGATION ;

CONSULTATION  ;

OTHER [describe]

DATE INCIDENT [first] HAPPENED or DATE BY WHICH FUTURE 
ACTION TO BE TAKEN  Month Date Year

      Please Enter Your Responses ["Yes" or "No" or Requested Details] 
Following Each Applicable Question

  FOR U.S. COAST GUARD or ADMINISTRATIVE LAW MATTERS,:

1. Is the Agency attempting to suspend, revoke or limit a license or document?

Yes or No

2. Have you put in a claim or application to the Agency?

Yes or No

1. IF SO, for what purpose or goal??

2. Has the Agency notified you of its action upon your claim or application?

Yes or No

3. Have any administrative law hearings been held,  yet,

1. IF SO, specify on what date and the result:

* the above information is necessary for a response.

Please call me as soon as possible.