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SAM HASLER

A TTORNEY AT L AW
1106 Meridian Plaza, Suite 251 Anderson, IN 46016
Telephone: 765-641-7906 Fax: (765)-374-3811
Web Page: http://samhasler.justia.net/index.html E-mail: samuelhasler@yahoo.com

INITIAL INTERVIEW - GENERAL INFORMATION

Date of Interview:
Name: DOB:
Address:

Home Phone: Work Phone:


Cell Phone/pager: Fax:
E-mail Address:
Social Sec No: Driver License No:
Spouse: DOB:
Children w/DOB:

Employer:

Type of Case:
Referred by:

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DO NOT WRITE BELOW THIS LINE
New Client: G G Matter: G New G Related to
Case Accepted G Yes G No
Case Not Accepted (Reason):

File Opened: File Closed:


Litigation Anticipated:

Estimated Time to Achieve Desired Result:


Fee: Retainer: Advance for Costs: