D.R. Roseen Attorney at Law, LLC O: +1 323 902 7779
931 Monroe Drive, NE Ste 102A-307 RoseenLaw.com
Atlanta, GA 30308 Support@RoseenLaw.com
General Intake for Corporate Clients
Thank you so much for contacting our law office! Please read the Privacy Policy below, and then fill out this form in its entirety prior to any consultation.
Note: Completion of this form does not create an attorney-client relationship. Representation begins only after a signed Engagement Agreement and Fee Arrangement.
Privacy Policy
All the information you provide our law firm as a prospective or current client is strictly confidential. Information collected is used only for evaluating potential representation and providing legal services, if retained.
Our firm takes every step possible to protect your privacy and the integrity of your information. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.
We collect personal information to verify your identity, run conflict-of-interest checks, and better understand your legal needs. Our firm will use your information in the event that you hire us to represent you/your company in your legal matter, and then only when necessary in limited use during the course of the case.
Some other examples of how this information may be used include:
initial service,
in court orders,
in required reports or other documents filed with the State.
If you have any questions, please don't hesitate to contact our office and direct your inquiry to one of the following departments:
Intake: intake@roseenlaw.com
Technology Support: tech@roseenlaw.com
Billing: billing@roseenlaw.com
General Assistance: clio@roseenlaw.com
We look forward to working with you!
Contact information
Prefix
First name
*
Middle name
Last name
*
Company
Emails
Email Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
Add email
Phone numbers
Phone number
Type
Work
Home
Mobile
Fax
Pager
Skype
Other
Primary
Default number false
Add phone number
What is your role / relationship to the company?
What trade names or “Doing Business As (DBA)” names are associated with your company, if any? (N/A if not applicable).
What is your company’s entity type (e.g., LLC, Partnership, Nonprofit, etc.)? (N/A if not applicable).
In what state(s) is your company incorporated/registered? (N/A if not applicable).
What is the formation date of your company? (N/A if not applicable).
What is your principal business address? (N/A if not applicable).
What is your business mailing address (if different than above)?
What is your company’s Entity ID / EIN? (N/A if not applicable).
Please provide information on the ownership and structure of your company, including major shareholders, owners, and members, subsidiaries or parent companies, and affiliates or joint ventures.
Please provide your company website and/or social media accounts. (N/A if not applicable).
Please provide a brief description of your legal issue, why you are seeking legal support, any adverse or opposing parties, and relevant deadlines or court dates.
Indicate which practice area(s) you think most closely correspond to your matter.
What outcome are you seeking?
Have you consulted with another attorney about this matter?
Yes
What is that attorney’s name and/or firm?
No
Have you previously been represented in this matter?
Yes
If yes, by whom?
No
Preferred Contact Method
Select an option
Email
Phone
No Preference
How did you learn about our law firm?
Friend or family member
Input the person's full name:
Another attorney
Input the attorney's full name:
Online search or lawyer directory website
Input the name of the website:
For example, "Avvo", "Facebook", or "LawFirmName.com"
Billboard, bus stop, phone book, newspaper, or other physical advertisement
Where was the ad located?
Radio or TV advertisement
What radio or TV station?
Bar Association
Which Bar Association?
Other
Please explain how you found us:
ADMINISTRATION & E-ACKNOWLEDGEMENT
If our law firm ends up representing your company in this matter, would you be the preferred billing contact?
Yes
No
Input the full name of the person who will pay the legal fees:
Input their title:
Input their phone number:
Input their email address:
Our firm recognizes that certain organizations—including non-profits, community-based entities, and small businesses with limited financial resources—may face challenges in accessing legal services. In select cases, we may offer reduced or sliding scale fee arrangements based on factors such as annual revenue, number of employees, and overall financial capacity. Eligibility for this program is determined through a brief application and supporting documentation, and approval is at the firm’s discretion. Availability may be limited depending on the scope and nature of the legal matter. Would you like to receive an application to be considered for our sliding scale program?
Yes
Please provide an estimate of your annual gross revenue and number of employees. Note: successful applicants typically have an annual documented gross revenue of under $75,00 and no more than 3-5 employees.
No
Please provide the full name and contact information for an alternative/emergency contact. (Optional)
We make every possible attempt to reach you prior to an emergency contact during true emergencies (e.g., medical incapacity, failure to respond to urgent deadlines). We protect confidential details, stating only we are your attorney and need to reach you.
ACKNOWLEDGEMENT AND ACCEPTANCE
I acknowledge that I have read and hereby accept the above Privacy Policy regarding use of my personal information. I understand that completion of this intake form does not guarantee representation. I further understand that an attorney-client relationship is formed only after a signed Engagement Agreement and Fee Arrangement, which must be completed at a later date.
Please type your full name to indicate your acknowledgment and acceptance:
THANK YOU
Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.
Please click the
SUBMIT
button below when you have finished answering all questions.