Client Intake Form

INSTRUCTIONS: Answer all questions truthfully and completely.

The information you enter in this questionnaire is confidential and protected by Attorney-Client Privilege. The information will not be disclosed to anyone outside of this office, except in the course of rendering legal services on your behalf, or unless otherwise required by law.

*Please email a picture of your (Oklahoma) Driver’s License - Front and Back to info@dg3law.com
*Please email Copy of Oklahoma Tax Permit Number (Dispensaries Only) to info@dg3law.com

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Social Security Number

Drivers License Number

License Expiration Date

YYYY

Issuing State

Date of birth

YYYY

What is your LLC name?

What percentage ownership do you share?

Are you the registered agent for your cannabis business?

(this is who is appointed to accept service of process and official mail on your business' behalf)

REGISTERED AGENT ONLY BELOW

(this and all remaining questions only for registered agent)

Effective date of LLC

YYYY

What county is your cannabis business in?

Street address of its principal place of business

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business email address

Will this place of business be your preferred business mailing address?

(IMPORTANT: This is where you will receive your license and all state documents.)

If no, please write your preferred business mailing address with city, zip code and state.

How did you hear about our office?

Client Intake Form

Gies Law Firm, PLLC