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Abacus Law Client In-Take Sheet Sample Law Area: Insurance AC Consulting Legal Office Technology & Automation |
LAW OFFICE INFORMATION SHEET
Current Date: ____________________
1. NEW MATTER INFORMATION
Matter Name: __________________________________________________
Claim No.:_____________________________________________________
Policy No.: ___________________________________________________
Attorney: _____________________________________________________
Court Case No.: _______________________________________________
Court: ________________________________________________________
Opened Date: __________________________________________________
Closed Date: __________________________________________________
Re-Opened Date: _______________________________________________
2. ADDITIONAL MATTER INFORMATION
Claims Handler: _______________________________________________
Abstract: _____________________________________________________
Liens: ________________________________________________________
Major Expense: ________________________________________________
Fast Track: ___________________________________________________
Policy Limits: ________________________________________________
Date of Loss: _________________________________________________
Claims Office: ________________________________________________
3. PLAINTIFF'S ATTORNEY INFORMATION
Last Name: ____________________________________________________
First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________
Fax: (_____)___________________________________________________
Pager/Cell: (_____)____________________________________________
4. PLAINTIFF'S PERSONAL INFORMATION
Last Name: ____________________________________________________
First Name: ___________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Home Phone: (_____)____________________________________________
Work Phone: (_____)____________________________________________
Fax: (_____)___________________________________________________
Pager/Cell: (_____)____________________________________________
5. CO-DEFENDANT INFORMATION
Gender (m/f): __________________
Last Name: ____________________________________________________
First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________
Client Name: __________________________________________________
Gender (m/f): __________________
Last Name: ____________________________________________________
First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________
Client Name: __________________________________________________
Gender (m/f): __________________
Last Name: ____________________________________________________
First Name: ___________________________________________________
Firm Name: ____________________________________________________
Address: ______________________________________________________
City/State/Zip: _______________________________________________
Work Phone: (_____)____________________________________________
Client Name: __________________________________________________
6. DISPOSITION
Amount of Settlement: _________________________________________
Total Hours: __________________________________________________
Suit Life: ____________________________________________________
Legal Allocation: _____________________________________________
7. CLOSING INFORMATION
Arbitrated: ___________________________________________________
Medralien : ___________________________________________________
Trial: ________________________________________________________
C&R: __________________________________________________________
Stipulation:___________________________________________________
Findings/Award: _______________________________________________
Substitution: _________________________________________________
Endorsed-Filed Dismissal Only: ________________________________
Endorsed-Filed Dismissal and Release: _________________________
Order Approve. 3rd Party C&R:__________________________________
THESE MATERIALS HAVE BEEN PREPARED BY AC CONSULTING FOR INFORMATIONAL PURPOSES ONLY AND ARE NOT TECHNICAL ADVICE. YOU SHOULD NOT ACT UPON THIS INFORMATION WITHOUT SEEKING PROFESSIONAL TECHNICAL COUNSEL. THE ABACUS IN-TAKE SHEET SAMPLE IS FOR INFORMATION PURPOSES ONLY. THE ENTIRE RISK OF THE USE OR THE RESULT OF THE USE OF THIS ABACUS IN-TAKE SHEET SAMPLE REMAINS WITH THE USER. LIMITATION OF WARRANTIES AND LIABILITY:
THE SAMPLE IS PROVIDED ON AN "AS IS" BASIS, WITHOUT ANY OTHER WARRANTIES OR CONDITIONS, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, WARRANTIES OF MERCHANTABLE QUALITY, SATISFACTORY QUALITY, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, OR THOSE ARISING BY LAW, STATUTE, USAGE OF TRADE, COURSE OF DEALING OR OTHERWISE. THE ENTIRE RISK AS TO THE RESULTS AND PERFORMANCE OF THE SAMPLE IS ASSUMED BY YOU. NEITHER WE NOR OUR DEALERS OR SUPPLIERS SHALL HAVE ANY LIABILITY TO YOU OR ANY OTHER PERSON OR ENTITY FOR ANY INDIRECT, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES WHATSOEVER, INCLUDING, BUT NOT LIMITED TO, LOSS OF REVENUE OR PROFIT, LOST OR DAMAGED DATA OR OTHER COMMERCIAL OR ECONOMIC LOSS, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR THEY ARE FORESEEABLE. WE ARE ALSO NOT RESPONSIBLE FOR CLAIMS BY A THIRD PARTY. OUR MAXIMUM AGGREGATE LIABILITY TO YOU AND THAT OF OUR DEALERS AND SUPPLIERS SHALL NOT EXCEED THE AMOUNT PAID BY YOU FOR THE SAMPLE. THE LIMITATIONS IN THIS SECTION SHALL APPLY WHETHER OR NOT THE ALLEGED BREACH OR DEFAULT IS A BREACH OF A FUNDAMENTAL CONDITION OR TERM OR A FUNDAMENTAL BREACH. SOME STATES/COUNTRIES DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SO THE ABOVE LIMITATION MAY NOT APPLY TO YOU. |