Revised: 08/13/09

Easy asChange Custody Online

Payment can be made through our payment center online or at the time of you initial phone consultation..

 Section I - Personal & Contact Information:

Note: All information put in Court documents becomes public record.  If you have information you wish to keep private then please inform us of that when we call for your consultation.

*Name   (Example John Public Doe)

Home phone Work phone   Cell phone    

(Example 602-896-9020)

*Email                            

Mailing address:

Street    Apt.

City  State  Zip

Date of birth  (Example 12-01-1963)

Social Sec. No. (Example 123-04-8789)

Who did you speak with from our office prior to completing this questionnaire?

                    Prior Case Information:

What is your case number  In the original case were you the Petitioner Respondent

Was your original case filed in the Maricopa County, Arizona Superior Court? Yes No

What was the date of your last custody order?  (mm/dd/yyyy)

What judge/commissioner signed your last custody order?  The Hon.

Section 2 - Other party's Contact Information:

*Name    (Example John Public Doe)

Home phone Work phone  Cell phone

(Example 602-896-9020)

Mailing or severable address:

Street  Apt.

City  State   Zip

Date of birth  (Example 12-01-1963)

 Social Sec. No. (Example 123-04-8789)

Section 3- Name of child(ren):

  Child's Name    
Child #1 
Child #2
Child #3
Child #4
  Date of Birth Place of Birth (City and State) Social Security Number
Child #1

 
Child #2

 
Child #3

 
Child #4

 

 

Section 4 - Financial Information

Based upon the figures below. Discount Divorce will calculate the child support as per Arizona Child Support  Guidelines as required by law.  Ariz.Rev.Stat. 25-320.

How is child support calculated?

          Note: If you and the other party have agreed upon a child support amount please let us know when we contact you.

Father's gross monthly income:  $  

Mother's gross monthly income: $

Day care cost (if any) $    

Medical insurance premium (if any) $  

What percentage of uninsured medical expense will you be responsible for? %

     If you leave this blank, then the percentage will be calculated proportionate to both incomes.

What percentage of visitation travel related expenses will you be responsible for?   %

     If you leave this blank, then the percentage will be calculated proportionate to both incomes.

Does either you or the other party have minor children residing with them from another relationship?

If, yes list their names, dates of birth, and who they live with (myself or my spouse)

 

(Example John Public Doe, 07/30/98)

Employment information of NON-Custodial Parent:

Employer  or  Unemployed or   Self-Employed

Address   (Street, City, State, & Zip Code)     

Section 5-  Current Custody Order

Select one:

Section 6-  Request Change of Custody

Select one:

What are the different types of custody?

 Shared custody option not recommended for parents living more than 25 mile apart.

If you selected No visitation you are telling the court that the other parent is an EXTREME Danger to the child(ren).

 If Supervised visitation was checked - Why do you want supervised visitation?  Check all that apply:

      Drug abuse  Alcohol abuse  Anger Management Issues and/or  Flight risk (parent will run off with the children)

Section 7- All Minor Children Involved in this Case

List all address or major cross roads for where the child(ren) resided for the last 5 years. Please include month and year. 

Example: 3 East Oak, Phoenix, AZ from 03/05 to 07/07 with mother

                                    or

19th Ave. & Bell Rd., Phoenix, AZ from 03/05 to 07/07 with mother    

Address   From   Until    
    Present  
     
     
     
     

Section 8 - Process Service

We must provide  a copy of the legal documents to the other party AFTER they have been filed with the Court.  What is the single best way to do this? 

Select one:

Option 1 The other party  will come into your office and sign them.

Fee: FREE

Option 2 I will take other party a copy of the documents.

Fee: FREE

Option 3 Send the documents by certified mail.

Fee: $25

Option 4 The other party will not sign anything. They must be served by a Process Server.

Fee: $95 Metro Phoenix / $150 Non-Metro Phoenix

Do I need a Process Server? How does Process Service work?

Option 5 I do not know the whereabouts of other party.

Fee: $100

How does Publication / Newspaper Divorce work?

If you stated you do NOT know the whereabouts of other party,

then when was the last time you seen them? (Example 05-01-1993)

Section 9 -Other information or comments  

Section 10-Payment Options

Discount Divorce will immediately begin work on your case as soon as your initial phone consultation is complete and your payment is received.

Pricing and cost information:

Discount Divorce will call you between the hours of 9AM and 4PM, Monday thru Friday.

What is the best time to reach you at during the hours listed above? until on

Payment & Acknowledgement

All costs will be discussed with you in advance, and we will not proceed or charge your card until you instruct us to do so.

Card number requiredNote: You are not obligating yourself financially by submitting this form.

*Number *Exp. Date *Type of Card

 

Terms of Service

I acknowledge that I have read the "Terms of Service" and agree and understand them.

*Applicant Name/Signature: All information contained herein is true and correct

*Date (mm/dd/yyyy):