Google LSA Intake Form Law Firm Principal (Owner) Information: First Name (Legal Name): Middle Name: Last Name: Date of Birth: Social Security Number: Bar Number: Email Address: Business (Law Firm) Information: Legal Business Name: Business Phone Number: State of Incorporation: Please select one: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Business Tax Filing Number (EIN): Year Established: Hours of Operation Weekdays: Hours of Operation Weekends: Number of Lawyers at the Firm (including yourself): Languages Spoken at the Firm (besides English): Office Locations (Please List All Locations of Focus for the Google Screened Program): Monthly Budget: Do you have Legal Malpractice Insurance? Please select one: Yes No protected by reCAPTCHA Privacy - Terms Share This Page:
