Theseoptional questionswill provide potential attorneys with specific details about your case.

The type of automotive product that caused an injury or needs to be replaced is a:

The product was purchased on this date:

The product was purchased from:

A business

An individual

The product cost this much money $:

The product was determined to be defective or caused injury on this date:

The product caused the following injuries:

No injuries

Cuts and bruises

Broken bones

Headaches

Nausea

Difficulty sleeping

Anxiety

Difficulty breathing

Impaired vision

Your Age:

Occupation:

Current status of the claim is:

No action taken yet

Demand for compensation made

Lawsuit filed

How well do you understand your legal situation or issue? Please select the statement that best applies to your situation:

I understand my legal issue.

I have a couple of questions.

Gross annual income:

$25,000 or less

$25,001-$50,000

$75,001-$100,000

$100,001-$125,000

$125,000+

One Line Summary of your Case: *

Describe your Case in Detail: *

First Name *

Last Name *

City *

State or Province *

Zip / Postcode *

Phone *

Email *

Contact Preferences

Release my contact infoto Attorneys *

Yes

Notify me when attorneys respond by: *

Text Message

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What level of experience would you like your attorneyto have?

No preference

6-15 years experience

1-5 years experience

over 16 years of experience

How Will You Pay?

Cash

Credit Card

Family

Check

Friend

I can't pay.