All items with an asterisk (*) must be filled in or we cannot accept your submission.

*First Name:
*Last Name:
Birthday:
Age:
Gender:	Male Female
*Email:
*Phone:	( )
*Cell Phone:	( )
*Street Address:
Apt # (if applicable):
*City:
*Zipcode:
*State or Province:	Please Choose Alabama Alaska Arkansas Arizona California Colorado Connecticut DC, Washington DC Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
	We need information about the person with whom you have the dispute.
*Defendant's First Name:
*Defendant's Last Name:
Phone:	( )
	What is the relationship between you and the defendant?
	Next we need general information about the lawsuit.
*How much are you suing for?
When did the incident or dispute occur?
*Please give us a brief description of your case:
Have you filed a small claims/civil case in court?	Yes No
	If you answered "yes" to the question above please answer the following
In what court?
What is the case number?
When is your court date?
Is there a counter claim?	Yes No
Has the defendant been served?	Yes No Unknown
	I am over 18 years of age