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Agent’s Certification

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General Information

Have you or your family worked with us before? If yes, please explain: *

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Worked with us before

Your Name *

Email Address *

Phone Number *

Are you married? *

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Spouse Name

Spouse Email Address

Spouse Phone Number

What's your home address? *

Street address, not P.O box, please

Do you prefer a different mailing address?

Do you prefer a different mailing address?

Mailing Address

Would you like to receive SMS messages? *

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Phone Number for SMS

Please select the services you’d like:

Estate Planning

Simple Wills
Complex Wills
Living trusts
Powers of attorney and medical directives
Gift trusts

Probate

Wills and letters testamentary
Heirship and letters of administration
Family settlement agreements
Funding of testamentary trusts

Trust Administration

Trustee resignation and succession
Trust amendments and modifications
Trust distributions
Trust terminations

If the options above aren't a good match, please tell us more about your needs.

What is the approximate value of the assets, probate estate, or trust we'll be assisting you with? (Don't subtract debts or other liabilities. Do include trust assets, life insurance death benefits, and other nonprobate assets).

Under $90,000
$90,000 to $1,000,000
$1,000,000 to $5,000,000
$5,000,000 to $10,000,000
Over $10,000,000
I'm not sure. I'll need your help to determine the value.
I prefer not to say at this time.

Is anyone involved (you or a spouse, child, grandchild, or other family or any fiduciary, e.g., your executor) receiving needs-based governmental benefits, such as Medicaid or SSI? (Medicare is not a needs-based program). If so, list their names and relation to you.

Yes
No

Needs-based governmental benefits

Is there a deadline we need to consider, such as upcoming travel, surgery, or a court date? If so, please explain.

Yes
No

Deadline

Depending on the type of services needed, hourly fees will be $425 for associate attorneys, and $575 for shareholders. Estate plans may be fixed fee, with simple will packages starting at $3,000 ($3,500 for married couples). Is this within your budget?

Yes
No
I'm not sure. Please contact me for clarification.

How did you learn about us? *

Read a print ad
Referred by someone
Internet Search
I'm an existing client
I'm a former client
A friend or family member worked with you before
Other

Print Ad Publication

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Other

Estate Planning

Are you married?

Yes
No

What is your spouse's name?

First

Middle

Last

Most spouses attend the initial interview together, and we prefer that, unless you want to keep your plan confidential. Will your spouse be attending?

Yes
No

Probate

If probate, what is the Decedent’s name?* *

First

Middle

Last

What was the date of death?

Trusts

If trust administration, what is the name of the trust?

Who is the current trustee? (If more than one, name all corporate and individual trustees)

No Trustee

No one is currently serving as trustee

If no one is serving as trustee currently, who was the last acting trustee?

No one has ever served as trustee

None. (No one has ever served as trustee)

When was the trust first funded?

I don’t know the exact date of trust formation.

I don’t know the exact date

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Bellaire ProbateAttorneys at Law

6750 West Loop South, Suite 920, Bellaire, TX 77401| Phone 713.662.3853

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