EmailMe Form - Rapidivorce

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Name of Spouse/Significant Other *

First Last

Cell Phone *

### - ### - ####

If cell and home phone are the same, then use the same number for both.

Home Phone *

### - ### - ####

Email Address *

Date of Birth *

Age *

Place of Marriage *

Date of Marriage *

Children of Current Marriage (Include Full Name, Date of Birth and Residing With) *

Are you currently paying support for these children? *

Yes

No

Are you currently paying alimony to current spouse? *

Yes

No

Are you and your current spouse living together now? *

Yes

No

Date of Separation *

Put N/A if not applicable

Have you or your spouse filed for divorce in court? *

Yes

No

If yes, list the date of filing.

Other than your children and/or spouse, are there any people living with you now? *

Yes

No

If yes, list their name and their relationship to you.

Are you employed? *

Yes

No

If yes, give the name and address of employer.

Job title

Date Hired and Current Salary

Do you have a Professional License? *

Yes

No

If yes, list the license #.

Please list your highest level of education attained and field of study. *

Do you have an interest in reconciliation? *

Yes

No

As far as you know, does your spouse? *

Yes

No

Are you presently seeing a counselor or therapist? *

Yes

No

If yes, is it:

Individual

Joint

Family

Do you presently have an attorney? *

Yes

No

If yes, list the name and phone number.

Date Time

MM / DD / YYYY

Are there joint bank accounts to which your spouse has access?

Yes

No

Does your spouse have credit cards you are responsible for? *

Yes

No

Do you have a will? *

Yes

No

How did you learn about Rapidivorce? (Give name and relationship where applicable) *

Please read the following terms and conditions before scheduling your initial consultation and submitting payment to Rapidivorce.

The initial consultation with Rapidivorce applies to new clients only. Rapidivorce currently services only Pennsylvania residents. The initial consultation lasts approximately two hours in length and has a charge of three hundred US dollars. This fee is non-refundable. The initial consultation is to determine if the divorce experts at Rapidivorce can assist you and your spouse with your divorce. Attending and paying the initial consultation does not guarantee that your divorce or facts will be appropriate for the services that Rapidivorce offers. An initial consultation can only be scheduled after the personal data form has been completed. If you have not already done so, please complete the personal data form. After paying for your two hour initial consultation and upon completion of the personal data form, please proceed with scheduling your initial consultation. In order to properly evaluate your divorce and determine whether the divorce experts can help, each spouse will have to independently complete the personal data form and initial consultation with a divorce expert. Again, an initial consultation does not guarantee that the divorce experts at Rapidivorce can assist you in your divorce. This is a fact specific inquiry and the initial consultation determines whether or not the divorce experts at Rapidivorce can assist you and your spouse with your divorce needs. Thank you, Rapidivorce.

Do you understand and agree to the above terms? *

Yes

No

Date Time *

MM / DD / YYYY