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FREE CASE EVALUATION

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If you've been affected by a trucking related accident or know someone who has been, you need the right Minnesota truck accident lawyer to represent you. Use the form below to tell us about your case so we can properly review the settlement you might be entitled to for your losses.


Free Case Evaluation - Minnesota Truck Accident Lawyer & Attorney

There is no charge for this evaluation - simply submit your information, and we will review your accident claim with you.

 Basic Information  
   
First Name: [required]
 		Last Name: [required]
Address: [required]
 		Address Line 2:
City: [required]
 		State: [required]
Zip Code: [required]
 		 
   
 Contact Information  
   
Home Phone:
 		Best Way To Reach Me [time and method]:
Mobile Phone:
 		Additional Contact Information [special instructions]:
Work Phone:
 		 
   
 Accident Information  
   
Date of accident:
Time of accident:
City where accident occurred:
State where accident occurred:
Location of Accident:
Do you have copy of police report?: Yes
No
Is an attorney currently representing you for this matter Yes
No
How did accident occur:
What injuries resulted from accident:
Name of your auto insurance company:
Other party's auto insurance company:
Name of your health insurance company:
Other forms of medical coverage company:
Medical expenses to date:
Do injuries Prevent Working: Yes
No
If yes when did you stop working:
Approximate Money Lost Due to Injury:
Describe vehicle damage and or other property damage:
Car rental and or transportation costs:
Other information:
How Did You Find Us:

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