If you prefer to complete this form by hand, click here. Please print all pages and provide the requested information.

Date

Name *

Spouse Name

Home Address

City

State

Zip

Years Living in Arizona

Email *

Phone

Your Employer

Your Work Phone

Spouse Employer

Spouse Work Phone

Your Social Security #

Spouse Social Security #

How Did You Learn About Us?

If "Personal Referral," Their Name

If "Other," Please Describe

Legal Matter You Wish to Discuss

If "Other," Please Describe


You may communicate the above information by:

  • clicking “Submit,” which will automatically send it via email to Mr. Stickell’s legal assistant, or
  • printing this page and faxing it to Mr. Stickell at 602-266-0036.

IMPORTANT: Please print and complete our acknowledgement form(six pages) and bring it with you to your meeting with Mr. Stickell.