Criminal Defense | Jeff Pierce Criminal Lawyer

Criminal Defense Intake (Information Request)

Important: Submitting this form does not create an attorney–client relationship and does not mean our office has agreed to represent anyone.

Please keep answers informational. Do not provide any confidential or sensitive case information at this time.

Third-party payment notice: The attorney-client privilege applies between the client and attorney only. Information shared by the client may not be shared with another simply because a third party makes a payment toward legal fees.

Acknowledgment 1

I understand this form does not create an attorney–client relationship.

Acknowledgment 2

I will keep answers informational and will not provide confidential or sensitive case information at this time.

Acknowledgment 3

I understand attorney-client privilege applies between the client and attorney only, and a third-party payer does not create a right to receive privileged information.

1) Who is this request for?

Is this request for you or someone else?

Your relationship to the person charged

Your contact information

Full name

Email

Phone (best number)

Alternate phone (optional)

Address

Address line 2 (optional)

City

State

ZIP

Best time to reach you (optional)

Backup contact permission

OK to text
By checking this box, I agree to receive text messages from Jeff Pierce Criminal Lawyer related to my inquiry or legal matter. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out, HELP for assistance. See Privacy Policy and Terms of Service. OK to email

If we can’t reach you by phone, we may use the checked options.

2) Person charged / under investigation

If you are the person charged, complete this section with your own information.

Full name

Date of birth (optional)

Phone (if not incarcerated)

Email (if any)

Is the person currently incarcerated?

Correctional facility / jail name (if applicable)

Facility location (city/state)

Booking / inmate number (optional)

Have you or anyone else been speaking on the jail phone?

Jail calls are often recorded. Keep it informational.

Any known contact restrictions (optional)

3) Stage of matter (current status)

Select the best current status

If “Other,” explain (informational)

If law enforcement investigation

Any search warrants?

Any statements taken?

Investigator name(s)

Investigator agency/department (if known)

Investigator contact (phone/email if known)

If in custody awaiting extradition

From where

To where

Trial date (if known)

Trial date

Trial time (if known)

Next court date / location / judge (if known)

Next court date

Location (court/city/county)

Judge (if known)

4) Custody and bond (if applicable)

Has bond been set?

Bond amount (if known)

Been before a judge / first appearance?

Have you contacted a bondsman?

Bondsman name (if any)

Bondsman telephone (if any)

5) Responsible party for fees (payment)

Who will be responsible for payments?

Reminder: third-party payment does not create a right to receive privileged information.

Third-party payer name

Third-party payer phone

Third-party payer email

6) Charges and incident information

Where did the charges/allegations arise? (county / city / state)

When did the incident allegedly occur? (date or approximate)

Charge(s) or allegation(s)

Arresting / investigating agency

Agency name / department (if known)

When were you / the person contacted by law enforcement? (date or approximate)

Arrest / charge timeline (inclusive)

When were you / the person arrested? (if applicable)

When were you / the person charged? (if applicable)

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