Intake Form - Refinance Full Name * First Middle Last Phone * (###) ### #### Email * Current Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Relationship Status * Single, never married Married Divorced Widowed Separated, not divorced Common Law Relationship What is the name of your spouse/common-law partner? Leave blank if you are not married or not in a common-law relationship. Your Occupation * If you are unemployed, retired, or a full time student, please indicate. Business Address * Address of your workplace. If you are unemployed/retired/student, please mark it as N/A. Address 1 Address 2 City State/Province Zip/Postal Code Country Business Phone * What is your work phone number? If you are unemployed/retired/student, please mark it as N/A (###) ### #### Is the property a rental? * Yes No Is this property a matrimonial home? * In other words, do you currently live in this property with your spouse or have you ever lived in this property with your spouse? Yes, I live in this property with my spouse OR Yes, I used to live in this property with my spouse. No, I have never lived in this property with my spouse. I have never been married. We like to thank our referrals! Can you please share who referred you to Gurleen Law or how you found out about us? * Thank you!
