Free Auto Defect Case Evaluation

The personal injury law firm of Norris & Cantu, L.L.P. represents and helps personal injury victims all over the state of Texas to recover all money damages they are entitled to. Please take a moment to provide us with the facts and other information about how you were injured. This information will help us evaluate your case and be prepared to discuss it with you when we call you. We look forward to visiting with you and one of our attorneys will be in touch with you shortly.

CONTACT INFORMATION
First Name:*
Last Name:*

*E-mail Address:
Home Phone:	- -
Cell Phone:	- -
Work Phone:	- - ext.
Street Address:
Address #2:
City:
State/Zip:	/
What is the best way to reach you? Please provide the best place, time and method for contacting you.

AUTOMOBILE DEFECT INFORMATION
Date of Accident:
Time of Accident:
City where Accident occurred:
Location of Accident?
Do you have a copy of police report? Yes No
Is an attorney currently representing you? Yes No
How did accident occur?:
What injuries resulted from accident?:
Name of your auto insurance company:
Name of your health insurance company:
Do injuries Prevent Working? Yes No
If yes, when did you stop working:
Describe Car damage and/or other property damage:
Other Information:
How did you hear about us?

The information contained in the Norris Cantu, LLP website is provided for informational purposes only, and should not be construed as legal advice on any subject matter.

Norris Cantu Law