SIMPLIFIED DIVORCE PROGRAM - DIVORCE QUESTIONNAIRE
PLEASE ONLY SUBMIT THIS QUESTIONNAIRE WHEN YOU ARE READY TO BEGIN THE PROCESS AND PAY THE APPOPRIATE FEES
Click the "Send Form " icon at the end of this form and it will automatically sent to us as an e-mail message. Important Do not hit the Enter key as the form will be submitted without being completely filled out.
PARALEGALS ARE NOT ATTORNEYS
Paralegals are not attorneys and are not permitted to give legal advice. By submitting this form I acknowledge that I have read, understand and agree to all terms and disclosures contained in this document.* ) are required.
First, Middle, Last Name *
Street Address *
Mailing Address (if different) *
City *
State or Country *
County *
Zipcode *
Home Telephone Number *
Work Telephone Number
Social Security Number *
Birthplace (State or Country) *
Date of Birth *
Number of this Marriage (1, 2) *
How Last Marriage Ended: Death, Divorce, Annulment *
Date Last Marriage Ended *
Race *
Education (1-12) *
College (1-5) *
First, Middle, Last Name *
Street Address *
Mailing Address (if different) *
City *
State or Country *
County *
Zipcode *
Home Telephone Number *
Work Telephone Number *
Social Security Number *
Birthplace (State or Country) *
Date of Birth *
Number of this Marriage (1,2) *
How Last Marriage Ended: Death, Divorce, Annulment *
Date Last Marriage Ended *
Race *
Education (1-12) *
College (1-5) *
Date of Your Marriage *
City & State of Marriage *
County of Marriage *
Date Last Resided Together *
Date Stopped Marital Relations *
Wife wants to change name to prior name?
Yes
No
Wife's former name *
Internet
Search Engine Used *
Keyword Phrase Used *
Second Keyword Phrase Used *
Third Keyword Phrase Used *
Other Internet Source *
Other -- Please specify
Yes
No
If Yes, Explain
E-mail Address
Please do not submit this questionnaire until you are ready to begin the process and pay the appropriate fees. A deposit of $600. is due when you begin our services. You may pay for your services by mailing a check or money order to our Reno address, or provide credit card information.
* (Fields below are required if you select Credit Card Method of Payment)
Card Holder's Name
Credit Card
Select Card
MasterCard
Visa
American Express
Discover
Diner's Club
Credit Card Number
Expiration Date (MM/YY)
Zipcode on CC Billings
Amount to Charge the Card $
If a third party credit card is used, that person must also complete and fax to (775) 322-5583 the Authorization Form .
By submitting this form to Nevada Divorce I am authorizing the charge to my credit card for this purchase, the same as if I had personally signed a credit card purchase/payment receipt and I will be responsible for all collection fees and any other fees associated with the collection of my payment, should it become necessary. If you wish to mail your payment, please mail to: Nevada Divorce & Paralegal Services, Inc.
s
Send Papers to me:
TERMS OF AGREEMENT: Customer understands that Nevada Divorce's costs total $900.00. Even if the spouse does not sign the papers or the case is cancelled our typing fees have been fully earned and no refund will be given; that these services do not include the preparation of replies, opposition to motions, motions nor any other pleading nor any other service. It is the intent of Nevada Divorce to assist clients in representing themselves in legal proceedings. The supervising attorney supervises the typing of the joint petition, filing, and decree of divorce.
Yes
No
Philippine Customers - I have reviewed the Philippine page on this web site and/or have consulted with a Philippine attorney to verify the validity of this action.
Yes
No
By submitting this form I acknowledge that I have read, understand and agree to be bound by all disclosures and terms as contained in this document and the web site.
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