Do You Have a Case?

We have provided the following online form as a convenient, free and confidential means to help you make the right decision and determine whether you have a case. Please include as much detail as possible. We will contact you as soon as possible after receiving your submission.
 
Should you need to speak to a legal professional immediately, call us 24/7 at 1-800-960-5551


First Name
Last Name
Address
City
State
Zip Code
Phone Number
Contact Fax
E-Mail Address
Date of Incident
Type of Accident
How Did the Injury Happen
Describe the Injuries
Any Other Comments
To help prevent automated submissions, please enter the letters in the image below.  
     Reload Image
   

Items in RED are required.
 Submit     Reset

 

© Copyright 2014, The Glenn Armentor Law Corporation, Lafayette, LA. All rights reserved.