Environmental Toxic Tort Case Inquiry Form

Free Case Evaluation - No Fee Unless We Win!

* denotes required fields
Personal Information
* Name
* Address
City
State
Zip Code
Daytime Phone Number
Evening Phone
Mobile Phone
* E-mail Address
   
Case Information
What chemicals have polluted your environment?
 
Trichloroethylene (TCE)
Perchloretholene (PLE)
Benzene
TBE
Lead
Arsenic
Chromium
Cadmium
Vinyl Chloride
Other (Specify)
Who did the polluting and what kind of facility do they have?
 
What type of pollution?
 
Groundwater
Air
Soil
If groundwater has been polluted, do you use groundwater for
 
Drinking
  Yes
  No
Private well
  Yes
  No
Municipal well
  Yes
  No
Please describe the results of all tests showing pollution of your property.
 
Have you incurred expenses needed to clean up your property? If so, explain.
 
 
* By typing "agree" into the below box you are confirming that you wish to send your information to Williams Cuker Berezofsky.