Basic Information

First Name:   Last Name:  Middle:

Street Address:   City:

State:   Zip:   County: Home Phone:  

Cell Phone:   Email:  

Alternate Email / Work:  Your Birthdate:  

Date of Marriage Or Date Initially Together:  Date of Separation:  

Do You have other household income:YesNo <\SELECT>  Source / Name of Person:

Your Case

Please indicate what type of case you have by clicking the drop-down menu:  Divorce Legal Separation Support Modification Custody Modification Paternity [Unwed Father] Grandparents Rights Wage Garnishment License Suspension Visitation Issue Contempt Against You Contempt Against Her <\SELECT>

Mothers Information:

Mothers First Name:  Mothers Last Name:

Street Address:  City:

State:  Zip:  County: Home Phone:  

Cell Phone:  Email:  

Alternate Email / Work:  Your Birthdate:  

Does X have other household income:  Yes No <\SELECT>  Source / Name of Person:

Children's Information:

Child's Full Name:  Birth Date:

Child's Full Name:  Birth Date:

Child's Full Name:  Birth Date:

Child's Full Name:  Birth Date:

The children reside with: Father Mother Grandparent Other <\SELECT>  Name of Person With Whom Children Reside:

What You Want

Please Indicate Your Goals For Your Case:

Goal #1:

Goal #2:

Goal #3:

Goal #4:

Goal #5:

Please indicate with as much detail as you can, what, specifically you want and what you would like to change. Tell me your story:

Based upon what you've written, above, state "why" you want it and why it's in the best interests of everyone concerned --- particularly your children:

If applicable, tell me if there is any substantial injustice or economic hardship in your case. Explain:

NBFR Full Consulting Membership

A full consulting membership with the National Brotherhood of Fathers Rights [Click HERE for More Info on Membership --- $875]  ] includes unlimited consultation with Dennis Gac for a period of one year; 365 days.  He literally programs your name and phone number into his personal cell phone and picks up when you call. The service is first class --- you’ll never have to get “jerked” around again. Dennis will map out a strategy for you, then almost literally hold you by the hand throughout the balance of your case….showing you what to do, what to say, how to say it, where to go, how to file papers, the works. All of Dennis’ comments are based upon the vicarious experiences of other members….so…you know it works! You can communicate with Dennis by phone, fax or email…he is very prompt about staying in touch.

Are you interested in Full Consulting Membership: Yes No <\SELECT> 

Are Payments Preferred:  Yes No <\SELECT> Payments maybe arranged in special circumstances; but, cannot go over too long a period of time. Payments are arranged on a case by case basis; so, please call Dennis at (206) 650-0250.

NBFR Custom Paperwork

Very simply, we can draft all the appropriate paperwork [Click HERE for More Info on Paperwork --- $975]  for “any” action that you’re planning to take …child support modifications, custody motions, divorces, tort claim lawsuits, drivers license reinstatements, paternity actions, property settlements and much more. Our service takes the headache away from you. So, combined with a full consulting membership the paperwork option can be “very lethal” for the X. Membership is required for paperwork option.

Are you interested in the Additional Paperwork Option: Yes No <\SELECT> 

Are Payments Preferred:  Yes No <\SELECT> Payments maybe arranged in special circumstances; but, cannot go over too long a period of time. Payments are arranged on a case by case basis; so, please call Dennis at (206) 650-0250.

SO THAT YOUR INFORMATION REMAINS PRIVATE AND SECURE, PLEASE FILL IN THE FOLLOWING SECURITY WORDS