National Brotherhood Of Fathers Rights Intake Form
First Name
Middle
Last Name
Your Age

Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email
Emergency Contact Person
Emergency Contact Phone

State Of Court Case

Case #

The "X's" Full Name
Her Name Used On Pleading Work
"X's" Age

Child #1 Name & Age
Child #2 Name & Age
Child #3 Name & Age
Other Children

Date Of Court Order
Describe Case: Divorce/Paternity/Support Modification/Custody Modification Etc

Your Average Monthly Income
Mothers' Average Monthly Income

Please Describe What Your Problem Is
What Are Your Goals Right Now/
What Do You Want To Accomplish

The National Brotherhood Of Fathers Rights Fee Structure is currently $675.00 for unlimited consultation for one year and $200.00 for paperwork in an uncontested case and $875.00 in a contested case. Can you pay these fees? If not, please explain and offer a potential payment arrangement for approval by our staff.
Explanation For Payment Of Fees:

Your Marital Status
Married Separated Divorced Domestic Partners
Single Parent Unmarried
 
Your Employment Status
Full Time Part Time Self Employed Student
Homemaker Retired Disabled Unemployed 

Your Educational Level
High School Vocational Degree Associates Degree Bachelors Degree Masters Degree
Doctoral Degree Post-Doctoral Studies Professional Certification 

Give A Brief Synopsis Of Your Case
Other Information You'd like to Tell Us To Help In Your Case