V. Erik Petersen

Tell Us About Your Case


Choose recipient:
Name:
Street Address:
City:
State:
Zip:
Email:
Home Phone:
Business Phone:
Cellular or Pager:
Facsimile:
Are you known by any other names?  Yes  No
If yes, list other names you have used:
What is your marital status?
Does this matter involve a business you own or run?  Yes  No
If yes, provide the business name, address, and phone:
If a business is involved, how is the business organized (if known)?
Are you employed?  Yes  No
If yes, please provide your job title and employer's name and address:
Can you be contacted at work?  Yes  No
What area of law does your situation involve (if known)?
Describe your situation, including any relevant dates:
How would you rate your legal needs described here?
Are any other people involved?  Yes  No
If yes, provide names, addresses (if known), and their relationship to you, if any:
Do you have any documents that could help explain your situation?  Yes  No
If yes, list those documents and their dates:
Are there other documents that you do not have access to that could be of assistance?  Yes  No
If yes, list those documents and their dates and locations (if known):
Describe how this situation has impacted you:
Describe what you would like to happen to resolve your issue (your preferred outcome):
Have other attorneys worked on this matter?  Yes  No
If yes, provide names, addresses, and a brief description of their involvement:
Special concerns:
Where did you hear about this website?



Security code:
Enter the code from the image below

Try another code
    

The contents of this contact form are provided by and are the responsibility of the person posting the email communication. Your email will not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. You acknowledge that any reliance on material in email communications is at your own risk.

409 Main Street    Second Floor, P.O. Box 403    Harleysville, Pennsylvania 19438    Email the firm
© 2010 by The Law Offices of V. Erik Petersen. All rights reserved. Site Design by Slick Ideas, Inc.   Slick Ideas