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.

Your Social Security Number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security Numbers are most often used to positively identify parties.

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

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

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

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Current Age

Date of Birth

Place of Birth (City and State)

Social Security Number

Driver's License Number

Marital Status

Single

Married

Separated

Divorced

Widowed

Do you have Children?

Yes

Are you currently employed?

Yes

How were you referred to our law firm?

Friend or family member

Another attorney

Online search or lawyer directory website

Physical advertisement

Radio or TV advertisement

Bar Association

Other

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?

Briefly Explain your need for representation and the facts surrounding your case.

Date of the alleged Offense

Please enter the Trial Date if you have one already.

Insert your Citation Numbers or your Case Number .

Document Uploads

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.

If you are unable to determine where to upload which documents, we are more concerned with having them for the consult than having them uploaded to the specific folder listed below so please upload everything and we will file it in the correct place.

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.

DUI Cases

DR-15 From (Advice of Rights in DUI Cases-Usually a Pink Form)

Add attachment

DR-15A From (Order of Suspension / Temporary License in DUI Cases-Usually a White Form with Red Writing saying Hearing/Driver's Copy)

Add attachment

MSP 33 Form (Intoximeter results - Usually a Pink Form)

Add attachment

MSP 33 Receipt (Intoximeter results - Usually a white receipt stapled to the MSP 33)

Add attachment

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.

Contact information

Current Age

Date of Birth

Place of Birth (City and State)

Social Security Number

Driver's License Number

Marital Status

Do you have Children?

Are you currently employed?

How were you referred to our law firm?

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

Area of Law you are requesting assistance with?

Briefly Explain your need for representation and the facts surrounding your case.

Date of the alleged Offense

Please enter the Trial Date if you have one already.

Insert your Citation Numbers or your Case Number .

Document Uploads

NOTE:

Citations / Statement of Probable Cause / Indictment / Police Report

Notice of Initial Appearance (Document From Commissioner)

Notice of Court Dates already Scheduled

Additional Documents

DUI Cases

DR-15 From (Advice of Rights in DUI Cases-Usually a Pink Form)

DR-15A From (Order of Suspension / Temporary License in DUI Cases-Usually a White Form with Red Writing saying Hearing/Driver's Copy)

MSP 33 Form (Intoximeter results - Usually a Pink Form)

MSP 33 Receipt (Intoximeter results - Usually a white receipt stapled to the MSP 33)

THIS IS NOT AN AGREEMENT OF REPRESENTATION

ACKNOWLEDGEMENT AND ACCEPTANCE

THANK YOU