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(419) 278-7015

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Client - Personal Information

Client Information:

Name:*

Social Security #:

Date of Birth:

Phone Number

Spouse Information:

Spouse Name:

Spouse Social Security #:

Spouse Date of Birth:

Spouse Phone Number

Additional Contact Information:

Address:

Preferred Email:

May we use this email to contact you in the future?

Yes

No

Will not be used for solicitation or advertising. Only for work related matters.

Residence School District:

Reside inside a Village/City?

Yes

No

If Yes, Village/City Name:

Did you move your residence in 2025?

Yes

No

Date of Move:

Provide Old Address:

Old School District, if different:

During 2025 did you buy or sell any type of virtual currency or NFT - (IE: bitcoin/tokens)

Yes

No

DRIVER'S LICENSE INFORMATION

Name:

DL #:

ISSUE DATE:

EXP. DATE:

Spouse Name:

Spouse DL #:

SPOUSE ISSUE DATE:

SPOUSE EXP. DATE:

BANKING INFORMATION

All government tax payments and refunds will be electronic. Please provide banking details.

If you have a refund, do you want it Direct Deposited?

Yes

No

Bank Name:

Bank Account Type

Checking

Savings

Routing #:

Account #:

Providing personable and professional legal services since 1911 to our clients and community for over 4 generations.

Contact

Phone: (419) 278-7015

Fax: (419) 278-2896

Email: lawoffice@deshlerlaw.com

Sunderman & Rode LLC

114 E. Main St., Box 54

Deshler, OH 43516

Hours of Operation:

M-F 9:00am-4:30pm

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