Client Intake Form

New and current clients can save time by sending or updating their information prior to coming in for an appointment and submitting this form online. Simply fill out the form and press submit at the end.

General Information

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Please fill out this form in its entirety. Bold font indicates required fields. Check this area for additional information as you work your way through the form.

Please add details of how you were referred or how you know Mr. Bass if you select one the last three options.

Contact Information

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Use this opportunity to let us know how you prefer to be contacted, or if a phone number or email should NOT be used to leave messages.

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Personal Information
Employment History
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Please include schools, degrees and any special job training.

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Business History

Please list all shareholders, members, partners, officers and directors.

For example, does the company have an operating agreement, subscription agreement, code of regulations, bylaws, shareholder agreement or closed corporation agreement?

For each claim please include relevant dates, the nature of the claim, the other party, and the result.

Attorney-Client Relationship

Checking this box is the same as signing a written copy of the agreement.

Please review the terms of the attorney-client relationship and check the box if you understand and agree to our representation.

STANDARD CLIENT TERMS AND CONDITIONS

New Clients are asked to review the following and sign below before we agree to representation. The updated terms below apply to all ongoing attorney client relationships with this firm.  Clients should review these terms for changes prior to re-engaging the firm.

We would like to thank you for entrusting your legal needs to The Law Offices of Leon David Bass (hereinafter the “Firm”).  We appreciate your confidence in us. If you agree to allow us to represent you, we will make every effort to continue to satisfy you with prompt, thorough and efficient legal representation.  It is our policy to confirm in writing the scope and terms of our engagement with all clients, who have both encouraged this practice and have found it to be useful.  Please review this information below carefully and let us know as soon as possible if you have any questions. 

The Law Offices of Leon David Bass is happy to be working with you.  After completing this form you will meet with an attorney.  If you choose to allow us to represent you and we agree to represent you, then the terms as discussed below will apply, unless you and the attorney enter into a separate agreement.  If a new agreement is signed, then this agreement will not apply to the extent that this agreement is inconsistent with the new agreement.  Please understand that the attorney-client relationship will go into effect until the attorney has 1) performed a conflict of interest check and has found no conflicts, and 2) the attorney has agreed to the representation in writing. By signing this agreement, you agree to the representation and to the terms herein. These terms are updated from time to time and posted online on our website at www.lawbass.com/k.html.  Unless you opt out by notifying us in writing, you agree to accept these terms and all updates as posted.

 

Customarily, each client of the Firm is assigned a principal attorney contact who is responsible for ensuring that you are and remain satisfied with all aspects of our representation.  I will be the attorney primarily responsible for work performed for you.  However, some other attorneys, law clerks, legal assistants and other staff from time to time in our firm will also assist me.  Undoubtedly, your work or parts of it will be performed by other lawyers and legal assistants under my general supervision.  Such delegation may be for the purpose of involving lawyers and legal assistants with special expertise in a given area or for the purpose of providing services on the most efficient and timely basis.  Whenever possible, we will advise you of the names of those attorneys and legal assistants who work on your matters. 

 

You should also understand that Leon Bass has an Of Counsel relationship with a separate law firm, Chester Willcox & Saxbe, LLP. This means that Mr. Bass is associated with all of Chester Willcox & Saxbe, LLP attorneys in such a way that you have an attorney client relationship with the entire firm and all of its attorneys and of counsel attorneys.  Therefore, all of the Chester Willcox & Saxbe, LLP attorneys and of counsel attorneys can work on your matter, and of course, the attorney-client privilege extends to all such attorneys.  This means that we can share your information with the Chester Willcox & Saxbe, LLP attorneys and of counsel attorneys; however, they are all bound by the attorney-client privilege.  This also means that if there is a conflict of interest between any client of any Chester Willcox & Saxbe, LLP attorney and you, then we may not be able to represent you and must follow the Ohio Rules of Professional conduct (ethics) rules with respect to how we will proceed.  Also, please note, that if you are here on behalf of a business, or we form a business for you, unless we otherwise both agree, we will be representing the business and not you personally or the individual members.

 

Ultimately, our fees will be based upon the reasonable value of our services, at our standard hourly rates. Of course, these rates are subject to change from time to time.  We are mindful of the costs of legal services, and understand that every client wishes to avoid unnecessary expense.  Accordingly, where appropriate we will utilize more junior lawyers, law clerks, and paralegals.  Currently, our standard hourly billing rate is $225.00 per hour for attorneys, $125.00-145.00 for law clerks, and $95.00-125.00 for paralegals, with a minimum of one-tenth increments.    If we utilize other attorneys or their staff on your behalf, their rates will apply and may be different than our rates. Chester Willcox & Saxbe, LLP rates vary and you should confirm their billing policies with them. Note that if you work with Chester Willcox & Saxbe, LLP attorneys, you may be asked to pay a separate retainer and you may receive a separate bill from them.   All rates and fees are subject to change periodically at our discretion and such rates will be posted within updated terms at www.lawbass.com/k.html.

  You will receive periodic statements showing our time actually spent on your project.  The attorney will ask you for a retainer fee and we will deposit your retainer into our IOLTA trust account, which is a type of bank account that is used to hold funds belonging to law firm’s clients.   If the total billing for this project falls short of your retainer or you have a balance at the conclusion of this matter, the balance will be returned to you upon request.  You will not receive interest from the funds we hold for you in our IOLTA account.  We will not transfer any money from the IOLTA account until work is actually billed to you. 

In addition, any expenses that we may incur on your behalf will be itemized in our invoices and will be your responsibility.  Such expenses customarily include such items as court or government filing fees, expert witness, messenger services, document reproduction, facsimile charges, travel expenses, postage, and long distance telephone charges.  However, no substantial out-of-pocket expense will ever be incurred by our office on your behalf without your prior written consent

 

Our Firm is committed to remaining at the cutting edge of modern computer technology and communications technology so as to provide our clients with optimum competitive advantage and technological efficiencies.  Therefore, in addition to the expenses listed above, if our firm accesses an online database for research on your behalf, you may be billed for this service at the actual rate charged to us or if billed to us on flat fee arrangement, at the rate of $2.00 per minute for most research and the current rate (averaging about $5.00) for other specialized research.   These billing arrangements are subject to change as our service plans change from time to time.

 

On occasion, instead of billing on an hourly rate plan, we may also agree to bill you for certain projects on a flat fee basis.  If we agree to this arrangement, we will fully explain the complete services that will provide to you and the total fee for these services.  We will also specify what expenses, if any, the fee will include and generally what expenses you will be responsible for in addition to the fee.  You will be responsible for any and all expenses other than the expenses specifically included in any flat fee.

You agree to be responsible for all such fees and expenses as explained above during the course of this representation.   We will on a regular basis, send you an invoice showing the amount of our fees and expenses attributable to each such additional matter.  Each invoice is payable upon receipt.  In the event that payment of any of our statements is not received by us promptly, we reserve the right to discontinue legal services and that we will have no further duty to represent you regardless of the status of any matter at that time, and we may apply finance charges to your balance and you agree to pay all such finance charges and fees and costs associated with collection including but not limited to reasonable attorneys’ fees.  In the event you are not in a position to pay our legal fees and expense promptly upon receipt of our invoice, we ask that you contact us to propose some other payment arrangement.  The fee structure set forth herein is not set by law, but rather is an understanding reached between you and the Firm, as formalized by this agreement.  You have the right to retain independent counsel to review this letter and any materials we prepare in the future on your behalf.  Also, please note, that if we do any type of work for you that requires future follow up such as business filings, trademark, etc, we will endeavor to remind you when such future filings, renewals, etc. are due; however, we cannot guarantee that we will be able to do so; therefore you agree to remain ultimately responsible for assuring that you timely file any future renewals or other documents.

You or we may terminate this relationship at any time (subject to your obligation to pay us according to the terms of this agreement) by giving appropriate notice to the other.  We will endeavor sufficiently in advance of any such termination on our part to use reasonable efforts to assure that you can retain alternative counsel without a lapse in representation. You understand and acknowledge that we have an express lien upon your files, consistent with applicable law and our code of professional responsibility. If we are not paid in a timely manner, we may choose to retain such documents to ensure your payment of any legal fees and/or expenses that are overdue.

  Please see also website terms and conditions and LawNotes Disclaimer, which are incorporated herein.

In general, we ask that you do not discuss your legal matters with anyone without first discussing any such third party disclosures with us.  In this way we can protect the attorney-client privilege.  Please ask us anytime you have any questions or if anything is not clear.  I hope that this letter provides you with a better understanding of the scope of our contemplated representation as well as the fee structure of this Firm for this matter. We always maintain our best effort to protect client information; limitations of the Internet sometimes allow email messages to be viewed by third parties. For this reason, email messages may not be protected by attorney/client privilege. If the terms of the engagement are acceptable, please sign the acceptance below and return it to me. By doing so, you acknowledge that; (1) you have received a copy of this letter; (2) that you have had an opportunity to discuss the contents with us and, if you desire, to have it reviewed by independent counsel; and (3) that you understand, accept and agree to abide by the terms hereof.