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Full Name
Phone
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Amount Requested
Date of Accident
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Motor Vehicle Accident
Slip / Trip and Fall
Construction Accident
Maritime Claim (Jones Act)
Railroad Claim (FELA)
Defective Product
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Fractured Bones? Please describe
Surgery? Please describe
Describe your most serious injuries
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Injury Cash Now
34841 Mound Rd. #355
Sterling Heights, MI 48310
p:
(855) 620-2079
f:
(586) 649-4409
