Client Name:

Date:

Submitting Attorney:

Responsible Attorney:

Client Code:

Type of client
(select one):

Contact Name:

Email:

Address:

City:

ST: ZIP:

Country:

Website:

Describe the Client's Business:

Number of employees:

List any affiliates or entities that are related in any manner to the client:

List the client's major competitors:

Nature of Representation:

What technology is involved in this representation:

Do you know of any potential conflict?
Yes No
Please explain.

List dates/items to be docketed below.