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.




Mailing address:

Street    Apt.




Date of birth  


Section 2 - Other Party's Contact Information:



Mailing or severable address:

Street  Apt.




Date of birth  



Section 3- Child information

  Child's Name    
Child #1


Child #2


Child #3


Child #4




Date of Birth Place of Birth (City and State)  
Child #1


Child #2


Child #3


Child #4




Section 4 - Financial Information

 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 Name  or  Unemployed or   Self-Employed


Please Include: Street, City, State, & Zip Code

Are you and the other party in agreement on an amount child support to be paid?    

If yes, what is that amount? $

Section 5- Current Child Support Order Information

What is your case number  

In the original case were you the

Was your original case filed in the Maricopa County, Arizona Superior Court?

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

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

How much is your current child support order $

How often does the NON-Custodial parent visit the child(ren) each year? days/year.

Section 6 - 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? 

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

 Section 8-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.

Payment & Acknowledgement

If you chose pay online please compete credit card information below:

Number Exp. Date Type of Card

CVV No. What is a CVV Number?

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):