Custom Intake Form

Thank you for contacting Rossi, Hamerslough, Reischl & Chuck.

We kindly request that you complete our Intake Sheet to the best of your ability. Once the intake is returned to us, our Client Relations Manager can review the information, check for potential conflicts, and follow-up to schedule an initial consultation for you as soon as possible.

Bold labels and This graphic indicates a required field. indicate required information.

CLIENT INFORMATION

Name(s)This field is required.

Role in TransactionThis field is required.

Residence AddressThis field is required.

Primary PhoneThis field is required.

EmailThis field is required.

Preferred Method of ContactThis field is required.

WHO ARE THE PARTIES INVOLVED

BUYERThis field is required.

SELLERThis field is required.

ANY OTHER INVOLVED PARTIES?This field is required.

CASE INFORMATION

Properties at IssueThis field is required.

Description Of IssueThis field is required.

Approximate Amount in Controversy (in dollars):This field is required.

RHRC ONLY
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