CONTACT US Legal Consultation Request If you or someone you know has an issue for which you would like a free legal consultation, please fill in the form below: First Name: Last Name: Telephone number Email Address: What type of legal issue do you need help with? Automobile accident (if yes, fill out accident information form below) Injury on the job Divorce (child custody, support, etc.) Juvenile Other (please specify below) Tell us a little bit about your issue*: *The Law Office of Steven V. Bennett does not store information entered here, and will not share any information with any outside agencies, persons, or organizations, unless you give us written authority to do so, and only for the purposes of expediting your case. Auto Accidents Only Please give us a few specific details about your automobile accident below: Date the accident occurred: Where did the accident occur? If possible, give cross-streets. Tell us in your own words how the accident occured, who was involved (i.e., drivers, passengers, etc.), and any other details you can remember. Were you injured in the accident? Yes No If yes, please describe your injuries below, what (if any) medical facilities you received treatment at, whether you needed an ambulance, and any other details you can remember about your injury. Please list below the total of any medical expenses you may have incurred or expect to incur in the near future as a result of this accident: Please describe below any property damage (e.g., damage to your vehicle) and whether your vehicle still needs repairs and if so, how much that is estimated to cost If your car was totaled, give the Kelly Blue Book value. Has a claim been filed with an insurance company? Yes No Please provide name of any insurance companies involved (your own, and that of the negligent party). If possible, give adjustor's name and telephone number.
Legal Consultation Request
If you or someone you know has an issue for which you would like a free legal consultation, please fill in the form below:
What type of legal issue do you need help with?
Automobile accident (if yes, fill out accident information form below)
Injury on the job
Divorce (child custody, support, etc.)
Juvenile
Other (please specify below)
Tell us a little bit about your issue*:
*The Law Office of Steven V. Bennett does not store information entered here, and will not share any information with any outside agencies, persons, or organizations, unless you give us written authority to do so, and only for the purposes of expediting your case.
Auto Accidents Only
Please give us a few specific details about your automobile accident below:
Date the accident occurred:
Where did the accident occur? If possible, give cross-streets.
Tell us in your own words how the accident occured, who was involved (i.e., drivers, passengers, etc.), and any other details you can remember.
Were you injured in the accident? Yes No
If yes, please describe your injuries below, what (if any) medical facilities you received treatment at, whether you needed an ambulance, and any other details you can remember about your injury.
Please list below the total of any medical expenses you may have incurred or expect to incur in the near future as a result of this accident:
Please describe below any property damage (e.g., damage to your vehicle) and whether your vehicle still needs repairs and if so, how much that is estimated to cost If your car was totaled, give the Kelly Blue Book value.
Has a claim been filed with an insurance company? Yes No
Please provide name of any insurance companies involved (your own, and that of the negligent party). If possible, give adjustor's name and telephone number.
