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Case Evaluation Form

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Car Accident

If you have been in a serious** car or motorcycle accident please fill out this form for a lawyer referral and case evaluation.
** broken bone, permanent disability or wrongful death.

daytime tel #
e-mail #
date of injury
city, state
zip code
detail injuries
date of birth
full case details

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Car Accident Lawyers Attorneys does not provide attorneys for all locations. We reserve the right to decline case referrals or responses without notification.


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