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 within 48 business hours 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
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 2020, The Glenn Armentor Law Corporation, Lafayette, LA. All rights reserved.