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Please provide the following information. The more information provided, the better we can assess your situation. ** Do no list a number or email address where calls, faxes, emails or pages could be received by the other party or anyone you do not want receiving them; rather, give a safe number or email address, or call us later when you obtain such safe contact information. We STRONGLY suggest that you create a new email account with a new password for any communications with us. Only list "safe" telephone numbers/email addresses. NOTICE: No representation is provided until a signed fee contract is received and the retainer is paid.