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Tell us what happened
1
Let's setup a free consultation. First tell us, was this a:
Car Accident
Slip & fall
Property damage (home, roof, etc)
Trucking accident
Cruise ship
Workers Compensation
Other
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2
Did the accident or injury occur within the last 3 years?
YES
NO
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3
Did the damage occur within the last 4 years?
YES
NO
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4
Were you working when the injury or accident occurred?
YES
NO
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Was the damage the result of a hurricane or tropical storm?
YES
NO
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Was a police report filed?
YES
NO
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7
Did you go to the hospital?
YES
NO
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8
Was the other party at fault?
YES
NO
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9
referral
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10
What's your name?
First Name
Last Name
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11
Email
example@example.com
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12
Phone Number
Area Code
Phone Number
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13
Upload any photos of the accident, injury or damage here (optional)
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By submitting this form, you give ZipClaims permission to contact you to further discuss this matter. Please note, no attorney client privilege has been created by completing this form.
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This field is required.
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16
Unique ID
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