PLEASE FILL OUT BOTH PAGES OF OUR CONFIDENTIAL INTERVIEW FORM AND RETURN TO FRONT DESK KENNETH VERCAMMEN & ASSOCIATES, PC ATTORNEY AT LAW 2053 WOODBRIDGE AVENUE EDISON, NJ 08817 PLEASE PRINT                               732-572-0500 NAME ____________________________________________________ ADDRESS _________________________________________________ CITY _______________________ STATE ____ ZIP ______________ CELL #(_____)_________________ PHONE-DAY(____)________________ NIGHT (______)_________________ TODAY'S DATE ____/_____/_____   E-MAIL ________________________ Referred By: __________________________________________   If referred by a person, is this a client or attorney?  If you heard about the law office on the internet, which search engine?  What search terms did you use? CHARGES/TICKETS ISSUED  [provide tickets, hearing notice and other important                                            papers to front desk to be copied] 1.         ____________________________________________________ 2.         ____________________________________________________ 3.         ____________________________________________________ 4.         ____________________________________________________ IMPORTANT INFORMATION Date of Offense: __________________ Time: _____ (A.M./P.M.) Your Age _____ Town: ___________________________  (street/location)?____________________ What Happened: ________________________________________________ _____________________________________________________________ ________________________________________________________________________________________________________________________________________________Write additional details on the back of this page. YOU MUST FILL OUT BOTH PAGES PRIOR TO SEEING THE ATTORNEY. Kenneth Vercammen, Esq. Confidential interview form    page 2 Other Persons Arrested or Witnesses: ______________________  ____________________________ co-defendant/ Witness Name          Their Address                  Phone No. ______________ ______________________________________ Name                    Address                                    Phone No. What statements did you give to the police? ____________________________ ______________________________________________________________________________________________________________________________ Occupation: _____________ Employer: _______________ Town: ________ [Attach your business card to clipboard.] Do you need your drivers license for work? ____ Distance driven to work: ____ Prior criminal convictions  or arrests (include description of each charge, date of conviction, and place of conviction. -If none, write none): ____________ ______________________________________________________________________________________________________________________________ Prior motor vehicle convictions, town and year(ex: drunk driving, no insurance, driving while suspended, etc. -If none, write none):____________________ _____________________________________________________________________________________________________________________________________________________________________________________________Prior Traffic ticket downgrades to no point tickets since 1999  [39:4-97.2]: 1. Town _______________________ Year ___________ [if none, write none] 2. Town _______________________ Year ___________ [Please note the DMV/MVC only permits 2 "no point" downgrades in 5 years.] What questions do you have/ how can we help you and anything else important: _____________________________________________________ _______________________________________________________________ _______________________________________________________________                 All paid clients receive a T-shirt, water bottle & Can Koozie upon request. Please ask upon paying the retainer. Please help yourself to all brochures in the reception area. If you have a business card, please attach it to the clipboard.  All clients are entitled to receive our Free Email Newsletter featuring updates in Traffic Law, Criminal and Personal Injury.  This page must be filled out before meeting with the attorney. Thank you.                 Thank you for contacting Kenneth Vercammen & Associates, PC for representation in a Municipal Court matter.              Legal Services To Be Provided- Please read! 1.    Office consultation with client 2.    Preparation of statement to provide legal services [ retainer agreement ]       setting forth fees and work to be performed; 3.    Offer sound legal advice to client; 4.    Preparation of letter of representation to Municipal Court after fee paid; 5.    Preparation of letter of representation to Municipal Court Prosecutor; 6.    Review documents supplied by client and court; 7.    Copies of all correspondence to Court and Prosecutor to client; 8.    Opening of file and client may have free client case folder, Municipal Court        brochure, DMV points brochure, and Website brochure; 9.    Review of necessary statutes and case law; 10.  Follow up with Municipal Prosecutor for discovery if suspension or jail is        likely; 11.  Prepare defense and mitigating factors; 12.  Miscellaneous correspondence, drafting of brief/ pleadings if needed; 13.  Review Court hearing notice and send letter to client to remind them of        hearing 14.  Travel to Municipal Court and Representation in Municipal Court. 15.  Preparation of End of Case Letter with client questionnaire. 16.  Free Brochures provided on other legal topics such as Personal Injury,        Worker's Comp, Wills, Probate and other matter we help clients 17.  Free subscription to monthly e-mail newsletter providing legal updates        and Invitations to client socials 19.  Answer specific questions after the case is over 18. Free T-shirts,  Can Koozie, Water bottle for clients - Please ask. 20 Free Magnets, USA Keychains, USA Flag Calendar   We will review and research necessary statutes and caselaw, speak with the prosecutor, prepare defenses and determine mitigating factors. We agree to provide conscientious, competent and diligent services and at all times will seek to achieve solutions which are just and reasonable for you.           Legal Fees.  Fees are to be paid at initial consultation (today).          Fees must be paid by VISA, Master Card, American Express, check, money order or cash.   Make checks payable to Kenneth Vercammen Law Office today.   Fees must be paid in full prior to a Letter of Representation being sent to the Court. Neither this office nor other area attorneys accept payment plans if the fees are less than $2,500. Fees are not reduced and not negotiable. Under the NJ Rules of Professional Conduct and Court Rules, we cannot send a letter of representation to the court until the Retainer is paid in full     What you should do: After you have retained [paid] your attorney, call the court, plead not guilty. In traffic tickets, the phone number is on the back of the ticket. Judges will often ask you how many tickets you have had in the past 5 years. You want to be accurate with your response. In traffic matters we recommend you contact DMV, now Motor Vehicle Commission and obtain a driver's license abstract. Call 888-486-3339 or 609-292-6500. Please note the DMV/MVC only permits 2 "no point" downgrades in 5 years. If you have 2 downgrades to unsafe driving 39:4-97.2, you must wait 5 years for another downgrade to unsafe driving 39:4-97.2. If you do not wait 5 years, the MVC computer will impose 4 points against you. Write your notes on the back of this paper during your interview [Mun Ct Questionnaire-rev 5/7/08 Non cl- G3]