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Case Review Submissions

• Over 62 Years of Experience

• Free Initial Consultation

• Flat Fees for Bankruptcies

Get the Compensation You Deserve

For a FREE, no-obligation consultation with an experienced attorney regarding cases of personal injury and wrongful death, please submit the following response form to Smith, Pappas & Jones, Ltd. We will respect the confidentiality of your information to the fullest extent. Form submissions are relayed to us through our highly secure servers.

Please tell us who you are and how we can contact you. This information is strictly confidential and will not be communicated to anyone. Gathering this information is necessary for the purposes of checking for potential conflicts of interest prior to responding to your request.

If you have any questions, call our office at (217) 345-6222 or stop by the office in Charleston, IL, at 622 Jackson Avenue.

We cannot respond without being able to do our conflict check. ALL fields are required.

Let us know who we can help you. If you feel more comfortable contacting us over the phone, give us a call as soon as possible to discuss your needs.

Case Reviews Page Form

First Name:

Last Name:

Number, Street, and Apt.:

City:

State:

Zip:

Email:

Day Phone:

Night Phone:

Please provide a brief personal background of the person needing assistance. The following information is for me:

Yes

If "No," my relationship to the following person is:

First Name:

Last Name:

Age:

Occupation:

For how long?:

Current or last employed:

City and State where last employed:

Highest grade completed:

Schools / College attended:

Degrees:

Year of degree granted:

Special training or experience in:

Why do you need help? Please provide us with a very brief overview, in 200 words or less, describing in general the subject matter of your request:

State the date you were injured or when you first learned that you had been injured?:

What occurred?:

Where did it happen? City:

State:

County:

Who caused the harm? Please type in the names and addresses of all the wrongdoers involved:

What damages were suffered? Describe the damage you have suffered:

When is the best time to reach you by telephone?:

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Case Review Submissions

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Case Reviews Page Form

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