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PLEASE FILL OUT BOTH PAGES OF OUR CONFIDENTIAL INTERVIEW
FORM AND RETURN TO FRONT DESK
KENNETH VERCAMMEN & ASSOCIATES, PC
ATTORNEY AT LAW
2053 WOODBRIDGE AVENUE
EDISON, NJ 08817
732-572-0500
PLEASE PRINT
NAME ____________________________________________________
ADDRESS _________________________________________________
CITY _______________________ STATE ____ ZIP ______________
CELL #(_____)_________________ PHONE-DAY(____)________________
NIGHT (______)_________________
TODAY'S DATE ____/_____/_____ E-MAIL ________________________
Referred By: __________________________________
If referred by a person, is this a client or attorney?
CHARGES/TICKETS ISSUED [provide tickets, hearing notice and
other important
papers to front desk to be copied]
1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________
4. ____________________________________________________
IMPORTANT INFORMATION
Date of Offense: __________________ Time: _____ (A.M./P.M.) Your
Age _____
Town: ___________________________ (street/location)?____________________
What Happened: ________________________________________________
_____________________________________________________________
______________________________________________________________
_______________________________________________________________
________________________________________________________________
___________________________
Write additional details on the back of this page. YOU MUST FILL
OUT BOTH
PAGES PRIOR TO SEEING THE ATTORNEY.
Kenneth Vercammen, Esq. Confidential interview form
page 2
Other Persons Arrested or Witnesses:
______________________ ____________________________
co-defendant/ Witness Name Their
Address Phone
No.
______________ ______________________________________
Name Address
Phone
No.
What statements did you give to the police? ____________________________
______________________________________________________________
________________________________________________________________
Occupation: _____________ Employer: _______________ Town: ________
[Attach your business card to clipboard.]
Do you need your drivers license for work? ____ Distance driven
to work: ____
Prior criminal convictions or arrests (include description
of each charge, date of conviction, and place of conviction. -If
none, write none): _______________
______________________________________________________________
_______________________________________________________________
________________________________________________________________
Prior motor vehicle convictions, town and year(ex: drunk driving,
no insurance, driving while suspended, etc. -If none, write none):______________________
_________________________________________________________________
__________________________________________________________________
__________________________________________________________Prior
Traffic ticket downgrades to no point tickets since 1999 [39:4-97.2]:
1. Town _______________________ Year ___________ [if none, write
none]
2. Town _______________________ Year ___________
[Please note the DMV/MVC only permits 2 "no point" downgrades
in 5 years.]
What questions do you have/ how can we help you and anything else
important: _____________________________________________________
_______________________________________________________________
_______________________________________________________________
All new clients are entitled
to receive our Free Email Newsletter featuring updates in Traffic
Law, Criminal and Personal Injury. Please help yourself to all brochures
in the reception area. If you have a business card,
please attach it to the clipboard. All paid clients receive
a T-shirt upon request. This page must be filled out before
meeting with the attorney. Thank you.
Thank you for contacting Kenneth Vercammen & Associates,
PC for representation in a municipal court matter.
1. Legal Services To Be Provided- Please
read!
We will review and research necessary statutes
and caselaw, speak with the prosecutor, prepare defenses and determine
mitigating factors. We agree to provide conscientious, competent
and diligent services and at all times will seek to achieve solutions
which are just and reasonable for you.
1. Office consultation with client
2. Preparation of statement to provide legal services
[ retainer agreement setting forth fees and work to be performed;
3. Offer sound legal advice to client;
4. Preparation of letter of representation to
Municipal Court after fee paid;
5. Preparation of letter of representation to
Municipal Court Prosecutor;
6. Review documents supplied by client and court;
7. Copies of all correspondence to Court and Prosecutor
to client;
8. Opening of file and client may have free client
case folder, Municipal Court brochure, DMV
points brochure, and Website brochure;
9. Review of necessary statutes and case law;
10. Follow up with Municipal Prosecutor for discovery
if suspension or jail is likely;
11. Prepare defense and mitigating factors;
12. Miscellaneous correspondence, drafting of
brief/ pleadings if needed;
13. Review Court hearing notice and send letter
to client to remind them of hearing
14. Travel to Municipal Court;
15. Representation in Municipal Court.
16. Preparation of End of Case Letter and client
questionnaire.
17. Free Brochures provided on other legal topics
such as Personal Injury, Worker's Comp,
Wills, Probate and other matter we help clients
18. Free subscription to monthly e-mail newsletter.
19. Answer specific questions after the case is
over
20. Invitation to client socials.
21. Free T-shirts, Magnets, Keychains, Pens for
clients, - Please ask
Legal
Fees.
Fees must be paid by VISA, Master Card, American
Express, check, money order or cash. Make checks payable to
Kenneth Vercammen Law Office today. Fees are to be paid at
initial consultation (today). Fees must be paid in full prior to
a Letter of Representation being sent to the Court. Neither this
office nor other area attorneys accept payment plans if the fees
are less than $2,500. Fees are not reduced and not negotiable. Under
the NJ Rules of Professional Conduct and Court Rules, we cannot
send a letter of representation to the court until the Retainer
is paid in full.
What you should do: After you have retained [paid] your attorney,
call the court, plead not guilty and give the court the name of
your attorney. In traffic tickets, the phone number is on the back
of the ticket.
Write your notes on the back of this paper during
your interview.
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