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Aviation Law    Admiralty / Maritime Law    Medical Malpractice    Personal Injury    Premises Liability    Products Liability    Professional Malpractice    Transportation    Wrongful Death Ø Continental Airline Disaster, Tropic Air Belize Ø Offshore Air Taxi Helicopter crash Ø Bell 206b helicopter GMC truck    collision during a commercial shot   If you have been injured in an aviation accident, whether it be a plane crash or airline disaster, you may be entitled to monetary compensation. For a free review of your airplane accident claim please fill out the Airline Accident Form below. An experienced personal injury lawyer will review your claim and may contact you to discuss your legal rights. There is no charge or obligation for this free evaluation. Title:* First Name:* MI: Last Name:* Email Address:* - Mr. Mrs. Ms. Dr. Home Phone:* Address: Mobile Phone: City: Work Phone: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY     Zip: Injured Person Information Date of Birth: (ex. mm/dd/yyyy) Whom are you inquiring on behalf of? Self Family Friend Client Other If you are NOT inquiring on your own behalf, what is your relationship? Is the person deceased? Yes       No If deceased, the cause of death as stated on the death certificate: Date of Death: Was there an autopsy performed? Yes    No    N/A Date of Accident:     Aircraft Type:  Select Airline Private Jet Helicopter other if other: Flight Number (if airline):  Original Point of Departure: Intended Final Destination: Brief Description of Accident: Describe/Explain Injuries Suffered: Case Information: Case Description: Please type here... To Help Us Better Serve You: Please tell us how /where you heard about us? Friend Advertisment Post Board AltaVista AOL Ask Jeeves Excite Fast Google Goto HotBot Infoseek Lycos Mamma Northern Light Sprinks Web Crawler Yahoo! Other search engine Other If you found us using a search engine, please tell us what search term(s) you used to find us? I understand that by filling out this free consultation form I am not forming an attorney client relationship. I understand that I may only retain an attorney by entering into a fee agreement and that by submitting this form I am not entering into a fee agreement. I agree that the above does not constitute a request for legal advice. I agree that any information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. I agree that if this matter requires advice regarding my home state, local counsel may be contacted for referral of this matter. I understand that email is not secure and thus I am forming only a semi-confidential relationship. I have read and agree with the TERMS AND CONDITIONS Yes    No By Clicking the box below, I agree to submit my case for a free case evaluation: * Indicates Required Fields

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