EBA’s Client Intake Form – EBA Executives Inc

EBA's Client Intake Form

Name *

Address

Street

Address Part 2

City

Country

Briefly explain what you may need advice about or assistance with today: *

Are there any other parties involved? (Examples: a friend, an employer, a neighbor, signor of a contract, etc. This should include parties on either side of your issue) *

Below, list or upload the documents (papers) that you think may help us to understand the issues. *

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Please classify your urgency in concluding this matter? *

Are we the first entertainment business affairs company you have consulted with regarding this matter? *

If No – Why didn’t you engage their services?

Have you ever been represented by an attorney before? Yes Or No / If Yes – Please state the circumstances *

Are you known by any other names? Yes Or No. If yes name(s). (A artist name, fictitious name, a nickname, a former name, your maiden name etc.) *

Where are you employed? *

If your mail is returned as undeliverable or telephone service terminated, please provide the name of someone (friend or relative) you believe will always know how to contact you. Name, Relationship & Address *

Address 1

Address 2

City

Country

Phone *

How did you learn of our office? *

PLEASE READ CAREFULLY & Sign Below

Following your initial interview, if you agree to engage the professional services of “EBA EXECS” and “EBA EXECS” agrees to represent you, we shall both sign an Agreement for EBA's Representation. The Agreement for EBA’s Representation will set forth the terms and conditions of “EBA EXECS” agreed services.

NOTICE: “EBA Execs” will not represent you with regard to any of the matters set forth by you herein during your consultation unless and until, both you and “EBA EXECS.” fully execute the proposed Written Agreement for “EBA Execs” professional services. Your signature acknowledges only that you received a copy of this completed information sheet and does not mean you have agreed to accept the professional services of “EBA Execs” hereunder.

Signature *

Date *

Form Submitted Successfully!

We will contact you as soon as possible.