Estate Planning Contact Form

Required fields are marked with a *

Personal Information

Full Name *

Email Address *

Telephone *

Date of Birth

U.S. Citizen?


Zip *

Incident Details

Incident Address

Incident Zip *

Marital Details

What is your marital status?

Spouse's Name

Spouse's Date of Birth

Is your spouse a U.S. citizen?

Spouse's state of residence

Have you or your spouse ever been divorced?

Will & Trust Distribution

For whom do you want to provide in your Will or Trust?

If you have children, do you wish to treat all of your children equally?

After your death, at what age do you want distribution to your children, if not immediately?

Will & Trust Distribution - Grandchildren

If you have grandchildren, do you wish to leave a specific amount of money or a percentage of your estate to them?

If so, how much and to whom?

At what age, if not immediately?

Will & Trust Distribution - Charities

Do you want to leave a specific amount of money or other assets to any charities?

If so, how much and to whom?

Name and addresses of charities


I own the following real estate (addresses)

Legal description

The property is held as follows

I have debt on this real estate with the following lender(s). Include names, addresses and telephone numbers.

Asset Value

Personal Property







Household Goods



Real Estate


Vacation Home

Rental Property


Outstanding Debts



Credit Cards

Medical Expenses


Special Concerns

Asset protection concerns

Elder law, Medicaid or Nursing Home concerns

Special needs of family members or other beneficiaries

Pending lawsuits

Pending divorce

Desire to disinherit a family member

Other concerns


How did you find out about us?

If someone referred you to us, who was it?

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.