Intake Form

Disclosure Consent: By completing this page, I consent to my above-stated personal identification and contact information being disclosed to banking and/or financial institutions and governmental and regulatory authorities who may make requests for such information in pursuance of their obligations under taxation laws and laws and regulations in force to protect against money-laundering and financing of terrorism. You understand submission of intake information and documents here does not guaranty an intake with the firm, and you understand that all intakes are at the discretion of the firm, L.E. Burgess, P.A. You understand that by submitting information or documents as part of this intake form is not a form of legal advice by L.E. Burgess, P.A., that L.E. Burgess, P.A. has no obligation to engage you or your entity as a client, and that any and all engagement by L.E. Burgess, P.A. will be in writing and signed by all parties involved.