Intake Form & Agreement

If you prefer to complete a pdf form instead, download our PDF Intake form below and return the form to our office per the instructions on the form:

Download PDF Intake FormOtherwise, Please Complete the following:

Use this form to request preparation of Retirement Division Orders:

Step 1 of 3

First Party Information:
Choose one:*
- Plaintiff / Petitioner A
- Defendant / Respondent / Petitioner B
Name*
First Middle Last
Your Pronouns
Don't know why we are asking? Click here.
Other Pronoun:
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Attorney's Name
First Middle Last
Attorney's Email
Attorney's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attorney's Phone
Second Party's Information:
Choose one:*
- Plaintiff / Petitioner A
- Defendant / Respondent / Petitioner B
Relationship to First Party:*
- Former Spouse
- Spouse
- Child
Name*
First Middle Last
Second Party Pronouns:
Don't know why we are asking? Click here.
Other Pronoun (2nd party)
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Attorney's Name
First Middle Last
Attorney's Email
Attorney's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attorney's Phone
Did you work with a mediator?*
- Yes
- No
Mediator Information:
Name
First Middle Last
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone

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Base Price ($750 x the number of plans):*
Price: $0.00
For each Plan the basic Preparation of Order (QDRO or DRO) costs $750.00

This includes the pre-approval process, but does not include any additional documents or assistance with court filings. That option can be added below.
If you have more than three accounts to divide, please complete the rest of this form and we will reach out to you to discuss bulk pricing options.
Additional Cost for Assistance with Request to Court and Submission of Final Order*
Once the order(s) are pre-approved our office can assist with obtaining everyone’s signatures, assist with submitting the documents to the court for the Judge’s signature, and then submit the document to the plan administrator for implementation. This option is charged for the first Order only.
Promotional Code:
Total
$0.00
Referred by?*
Please let us know how you found us:
- Internet Search
- Referral from Attorney or Mediator
- Referral from Vesta
Once you have submitted this form we will send you an Invoice from Stripe and a request for additional information specific to your plan type.
Send Invoice to:*
- Pay Online with Credit Card
- Plaintiff / Petitioner A
- Defendant / Respondent / Petitioner B
- Split Equally between both parties
Credit Card
Card Details
Cardholder Name
Additional Notes (if any):
The undersigned customer(s) are requesting specific forms services from Gray Jay Endeavors, LLC (“Gray Jay”) as described above only. The customer(s) intend to retain control over all aspects of their cases and be responsible for all decisions made in the course of their case. The customer(s) acknowledge that the requested services are not a legal service and Gray Jay is not a law firm. If customer(s) need legal advice they are directed to consult with their own individual attorney. Customer(s) acknowledge that Justin Kelsey, owner of Gray Jay Endeavors, LLC, also works with Skylark Law & Mediation, PC. Any services provided by Skylark Law & Mediation, PC or Justin Kelsey, outside of the services requested here, may create an actual or perceived conflict of interest. By signing this Agreement, customer(s) agree to waive any actual or perceived conflict. Customer(s) acknowledge that Gray Jay maintains a paperless office and as such uses various Internet‐based cloud-computing services for various purposes, including storing, backing‐up, and sharing documents (including confidential and privileged documents), tracking time and tasks for projects, managing contact information, and sending electronic communications. Customer(s) give express, informed consent for Gray Jay to use cloud computing in connection with this matter. This written Agreement governs the entire relationship between Customer(s) and Gray Jay. All amendments shall be in writing and attached to this agreement. Signature by fax or electronic device digital signature is expressly authorized and shall have the same force and effect under this Agreement.
Type your name as your BINDING SIGNATURE:*

By entering your name below you Accept these terms. I have carefully read this Agreement and believe that I understand all of its provisions.
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Intake Form & Agreement

Step 1 of 3

First Party Information:

Second Party's Information:

Mediator Information:

First Plan Information:

Second Plan Information:

Third Plan Information: