Personal Information

Name

E-mail

Street Address

City

State

Zip Code

Phone

Fax

Marital Status

Sex

How did you hear about us?

Appointment Request

Please note that appointments are normally available beginning between 9:00 am and 5:00 pm weekdays Eastern US time.  Appointments normally take a half hour or less and can begin on the hour or half hour. If you need an appointment on the same day, in the evening, on a holiday or on a weekend, please call us at 800-597-0529 after submitting this form and we can see if the request can be accommodated. Please fill out 3 requests in case if we are booked.

Request #1 Date and Time

Request #2 Date and Time

Request #3 Date and Time

How would you like to be contacted?

When you would like to be contacted?

Agreement Information

PLEASE READ THE FOLLOWING AND TYPE “YES”, IF YOU AGREE, BEFORE SUBMITTING THIS FORM

I understand that a telephone consultation is not free and is charged as described at the top of this page. I further understand that submission of this form does not create an attorney-client relationship and Sumner and Associates is not obligated to schedule a consultation with me.

I agree    (Yes or No)
 

Billing Information

Sumner and Associates will need your payment information prior to your appointment. You can provide that information on this secure web form, e-mail this information to us at admin@sumnerpc.com, or call the number in to scheduling assistants at 800-597-0529 or 248-650-0055.

Name as it appears on the credit card

Billing Address

Credit Card

Credit Card Number

Expiration Date