Do I have a Case?

Please be advised that this information is kept confidential and that by submitting this information you are not establishing a client-attorney relationship. Our attorneys will evaluate your case and will normally follow up with you within 24 hours of submitting this form.

*Name:
*Email:
*Phone Number:
Alternate Phone Number:
Address:
City:
State:
ZIP:
Company you were employed by:
Start date of your employment:
Date of termination (if terminated):
Did you have an employment contract?: Yes    No
What was your title or position?
What was your estimated
annual compensation?
What is your age?
How many employees
does the company have?
What is the name of
your supervisor?
Questions/Comments:
Please do not include any confidential or sensitive information in this form. This form sends information by non-encrypted e-mail which is not secure.

Submitting this form does not create an attorney-client relationship.