Client Registration

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Client Name

calc_combined_display_name_and

This field is hidden when viewing the form

Name

lex_firm_id

lex_provider_id

lex_client_id

lex_matter_id

ep_link

ep_url

ep_token

Gender

Male

Female

First Name*

Middle Name

(Optional)

Last Name

Name Suffix

(Optional)

Preferred First Name

Other names?

Yes

No

Other Name(s)

's Marital Status

What is this person‘s current marital status?

this person's Spouse's Name

This field is hidden when viewing the form

Name

lex_spouse_id

Gender

Male

Female

First Name*

Middle Name

(Optional)

Last Name

Name Suffix

(Optional)

Preferred First Name

Other names?

Yes

No

Other Name(s)

's Address and Residence

's Physical Address

Enter a physical address. P.O. boxes are not allowed.

Street Address Address Line 2 (Optional) City State / Province / Region ZIP / Postal Code Country

Will use a different mailing address?

Yes

No

's Mailing Address

Enter the address where mail is received. P.O. boxes are allowed.

Street Address Address Line 2 (Optional) City State / Province / Region ZIP / Postal Code Country

‘s State of Residence

‘s County of Residence

's Contact Information

‘s Email Address

Enter Email Confirm Email

‘s Phone Number

's Contact Information

‘s Phone Number

‘s Email Address

Enter Email Confirm Email