Law Office of Mark Muffoletto, LLC

3201 Rogers Avenue, Ste 301
Ellicott City, MD 21043

(410) 465-4665

Thank you for contacting our office! Please read the privacy policy below, and then fill out this form in its entirety at least 24 hours prior to our consultation.

In addition, we will need all documents related to your consult at least 24 hours prior to the appointment date and time.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

Contact information

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Middle name

Last name *

Date of birth

Company

Emails

Address *

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Upon submission, a copy of this form will be sent to the primary email.

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Addresses

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Phone numbers

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How were you referred to our law firm?

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If our law firm ends up representing you in this matter, will you be the person who pays the legal fees?

Yes

Area of Law you are requesting assistance with?

Are you the Plaintiff (bringing the suit) or the Defendant (the suit is or will be against you)?

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Defendant

Briefly Explain your need for representation.

Please explain your desired outcome and/or expectations.

DOCUMENTS: Please upload all files related to your case so we can review for your consult. NOTE: If we do not have the related documents PRIOR to your consult, you will have to reschedule.

NOTE:

If you are unable to use a full sized scanner, please use a PDF scanner app as such as JotNot, CamScanner, or PDFelement instead of just sending pictures of the documents.

THIS IS NOT AN AGREEMENT OF REPRESENTATION

ACKNOWLEDGEMENT AND ACCEPTANCE

I understand that this form does not create a binding agreement or an attorney/client relationship and one will not exist until a retainer agreement is executed. I acknowledge that I have read and hereby accept the above privacy policy regarding use of my personal information.

THANK YOU

Thank you for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We look forward to discussing the case further with you.

Please click the SUBMIT button below when you have finished answering all questions.