Untitled Document

Easy asChange Custody Online

Instructions:

Complete this questionnaire with as much information as possible.

If there is anything you do not know, then just leave it blank or type in unknown.

After you submit this questionnaire to us we will call you within 1 business day so we can discuss your case.

Payment can be made through our payment center online or at the time of you initial phone consultation.

You can also call or email us if you have any questions anytime.

All information is kept private and is secured through SSL 128-bit (secure socket layer) encryption

Section I - Personal & Contact Information:

Note: All information put in Court documents becomes public record. If you have information you wish to keep private then please inform us of that when we call for your consultation.

Name (first, m.i., last)

Cell phone email

Work phone Home phone

Mailing address:

Street    Apt.

City State Zip

Date of birth (mm/dd/yyyy) Social Sec. No.

How did you 1st hear about us? Web site Yellow pages Referral I am a previous client Billboard Other

     If you where referred, who referred you?

What is your case number In the original case were you the Petitioner Respondent

Was your original case filed in the Maricopa County, Arizona Superior Court? Yes No

What was the date of your last custody order? (mm/dd/yyyy)

What judge/commissioner signed your last custody order? The Hon.

Section 2 - Other Party's Contact Information:

Name (first, m.i., last)

Cell phone

Work phone Home phone

Mailing or serveable address:

Street Apt.

City State Zip

Date of birth (mm/dd/yyyy) Social Sec. No.

Section 3- Child information

Name of child(ren): First, M.I. Last

Child #1 child lives with Mother Father

Child #2 child lives with Mother Father

Child #3 child lives with Mother Father

Child #4 child lives with Mother Father

Dates of birth for each child (mm/dd/yyyy)

Child #1 Child #2 Child #3 Child #4

Places of birth for each child (city and state)

Child #1 Child #2

Child #3 Child #4

Social Security Numbers of each child.

Child #1 Child #2

Child #3 Child #4

Section 4 - Financial Information

Based upon the figures below. Discount Divorce will calculate the child support as per Arizona Child Support Guidelines as required by law. Ariz.Rev.Stat. 25-320.

Note: If you and the other party have agreed upon a child support amount please let us know when we contact you.

Father's gross monthly income:  $ Mother's gross monthly income:$

Day care cost (if any) $ Who pays for this? Mother Father

Medical insurance premium (if any) $ Who pays for this? Mother Father

What percentage of uninsured medical expense will you be responsible for? %

What percentage of visitation travel related expenses will you be responsible for? %

Does either you or your spouse have minor children residing with them from another relationship? No Yes

If, yes list their names, dates of birth, and who they live with (myself or my spouse)

Employment information of NON-Custodial Parent:

Employer or Unemployed or Self-Employed

Address

                      Street, City, State, & Zip Code

Section 5- Current Custody

Answer all questions that pretain to the acutal court order currently in place.

Who was awarded PHYSICAL custody in the last court order?

Mother Father Both parents (shared or split custody)

What type of LEGAL custody was awareded?

Shared - The court ordered that the child(ren) reside with both parents equal amount of time.

Joint - The court ordered that both parents have equal decision making power but the child(ren) primarly live with the parent with PHYSICAL custody.

Sole - The court ordered that the parent with PHYSICAL custody makes all decisions.

Split - The court ordered that one or more of the child(ren) resides with me and the other child(ren) with the other parent.

Type of Visitation was Awareded in Last Court Order:

Standard - Everyother weekend and shared holidays.

Supervised - Parent was declared a danger or flight risk.

None - Parent was declared EXTREME danger.



Section 6- All Minor Children Involved in this Case

List all address or major cross roads for where the child(ren) resided for the last 5 yeaactualease include month and year. If more address are applicable then please list them below in Section 12 - Other information or comments

Example: 3 East Oak, Phoenix, AZ from 03/05 to 07/07 with mother

19th ave. & Bell Rd., Phoenix, AZ from 03/05 to 07/07 with mother

from to Present      with Mother Father Both

from to with Mother Father Both

from to   with Mother Father Both

from to with Mother Father Both

from to with Mother Father Both

Section 7 - Requested Change of Custody:

Who do you want to have PHYSICAL custody?

Mother will have physical custody

Father will have physical custody

Mother and Father will both have physical custody

What do you want the LEGAL custody changed to?

Joint - Both parents share equally in decision making for the child(ren)

Sole - The parent with physical custody will make all final decision regarding the child(ren)

Shared - The child(ren) will equally live with both parents

Split - One or more of the child(ren) will reside with me and remaining child(ren) will reside with the other parent.

I want the visitation to be:

Standard - Every other weekend and shared holidays

Supervised - Other parent has a history of drug, alcohol, and/or anger management issues

None- Other parent is an EXTREME danger to the child(ren)

     If Supervised visitation was checked above, then why do you want supervised visitation? Check all that apply:

     Drug abuse Alcohol abuse Anger Management Issues and/or Flight risk (parent will run off with the children)

Section 8 - Process Service

We must provide the other party a copy of the legal documents AFTER they have been filed with the Court. What is the single best way to do this?

They will come into your office and sign them.

I will take the other person a copy of the documents.

Send the documents by certified mail.

They will not sign anything. They must be served by a Process Server.

I do not know the whereabouts of the other person.

     If you stated you do NOT know the whereabouts of the other person, then when was the last time you seen them? (mm/yyyy)

Section 9 -Other information or comments

Section 10 -Payment Options

Discount Divorce will immediately begin work on your case as soon as your initial phone consultation is complete and your payment is received.

Discount Divorce will call you between the hours of 9AM and 5PM, Monday thru Friday.

What is the best time to reach you at during those hours?

Payment Options

Choose Option Option below.

All information is kept private and is secured through SSL 128-bit (secure socket layer) encryption

After payment option is chosen please click the submit button below and your questionnaire will be sent to us.

Option Over the phone by credit card during phone consultation.

Please enter card no. below and card will charged after your

Credit/Debit card required for this option.

Number Exp. Date Type of Card

Note: You are not obligating yourself financially by submitting this form.
All costs will be discussed with you in advance, and we will not proceed or charge your card until you instruct us to do so.

Option Using PayPal® or credit/debit card via this secured website.

Service Agreement:

By clicking the "Submit" button I agree and understand the following: Discount Divorce Professionals is not a law firm. Discount Divorce Professionals is a document preparation service I (the client) understands that Discount Divorce Professionals, LLC. not a law firm and is a document preparation company and its representatives cannot give legal advice. This is to include division of assets and debts, custody, visitation, and child support, spousal maintenance (alimony), retirement accounts, jurisdiction concerning the parties or children of the parties, and any other issue concerning my case. I understand that Discount Divorce Professionals, LLC. cannot guarantee that any case can be completed within a certain amount of time due to unforeseen factors such as Court's case load or internal or external factors. I understand that Discount Divorce Professionals, LLC. is document preparation service only. (Court running, filing, and processing is at the sole discretion of Discount Divorce Professionals, LLC. and this "Agreement & Receipt" does NOT constitute a contract for these services. I acknowledge that Discount Divorce Professionals, LLC. supplied me with a "Consumer Protection Letter" I agree to all terms contained in the "Consumer Protection Letter" as well. I further acknowledge that Discount Divorce Professionals, LLC. has given me a copy of "How the Program Works" and I fully understand it completely. I understand that this is the complete agreement (Agreement & Receipt and the terms of the Consumer Protection Letter) and that no employee or agent of Discount Divorce Professionals, LLC. may alter this agreement unless done so in writing. I agree that Discount Divorce Professionals, LLC. is preparing only the following documents for the price agreed herein. Proof Reading Documents I understand that I am responsible for proof-reading documents for typographical and other errors before signing finished documents. I agree that I will hold Discount Divorce Professionals, LLC., its stockholders, representatives, or any other person connect harmless and not liable for any errors or omissions regardless of who fault it maybe. I understand that Discount Divorce Professionals, LLC. makes no warranties either expressed or implied. Furthermore, I understand that once documents are printed any changes before filing with the Court are subject to an amendment fee of $25 minimum if you want information changed. Privacy Policy I understand that when an e-mail address, telephone, or fax number have been given to Discount Divorce Professionals, LLC., it is assumed that I have have already taken the appropriate steps to protect my own confidentiality and privacy as necessary. All information provided to Discount Divorce Professionals, LLC. will be treated as confidential. I also understand, no "Attorney-Client Privilege" exists because Discount Divorce Professionals, LLC. is not a law firm and I they are subject to subpoena and can be ordered to testify. Guarantee of Service I understand that there is no guarantee that any of the information, applications, or forms provided by Discount Divorce Professionals, LLC. will be accepted by any courts or government agencies. There is no guarantee that I will receive favorable results for which have been applied for. I understand documents and information provided by Discount Divorce Professionals, LLC. do not give me any advantage over documents and information provided by any other legal, paralegal or business information service company, any other attorney, any other financial advisor, etc. Supplementation Information I understand that Discount Divorce Professionals, LLC. cannot be held responsible for the veracity and/or reliability of information provided by me or by any third parties (such as agents, attorneys or government entities). Web Site Content I understand that comments and other information presented in the Discount Divorce Professionals, LLC. web site are generalizations and may not apply to every situation. Matter included there may not be current and is subject to change without notice. Since Discount Divorce Professionals, LLC. is not an attorney, no attorney client relationship is established by the viewing, use, or communication in any manner through its web site. Refund Policy I understand that because work starts immediately, Discount Divorce Professionals, LLC. does not accept cancellations THERE ARE ABSOLUTELY NO REFUNDS UNDER ANY CIRCUMSTANCES, OR ANY PART OF A REFUND TO INCLUDE FILING FEES AND PROCESS SERVICE FEES. All fees are earned when paid. If I choose to stop my divorce or other action/documents I will not be entitled to any refund of any part of my fees, under any circumstances. This includes court costs, process service and all other fees. Payment Policy I understand that when I submit my credit card information over the Internet, phone, or in Discount Divorce Professionals, LLC. office, this is assumed to be a credit card authorization for the service requested, the same as if I had personally signed a credit card receipt. An additional credit card authorization (requiring a signature to be returned by fax or mail) may or may not be required, at Discount Divorce Professionals, LLC.'s discretion. I understand that if I do not pay in full at my initial appointment then Discount Divorce Professionals, LLC. will charge my credit/debit card on the agreed upon dates and that I cannot change those dates for any reason. Furthermore, if any payment becomes past due then there will be a $25 late fee accrued every 30 days until paid in full. I understand that if I am late on any payment all fees shall be due immediately. Late fees shall not exceed $100. If there is no schedule of agreed upon dates then any remaining balance is due within 30 days of this "Agreement & Receipt". I also understand that all payments can be made via the Internet at DiscountDivorceAZ.com as well. Filing and/or Process Service Fees Filing and /or process service fees can be voided if you do not have your documents filed in a reasonable amount of time, usually within approximately 60 days of the date on this agreement. This is because we write live checks for these fees at the time the "Agreement and Receipt" is signed by you. It is our policy not to keep live checks for more than 60 days in anyone's file. However, we can make an exception if you need an extension of time. It is your responsibility to contact us to request additional time prior to the date shown on this agreement. If after 60 days we do not hear from you we assume you do not want to continue the case and have abandoned it for whatever reason. Ver. 2.0 as of 8/21/07 ONLINE OSC Questionairre.