Address:
500 South Chinowth St. Suite 103
Visalia, CA 93277
Call:
(559) 733-3858
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Law Offices of Joseph C. Durante, Jr.
Home
About Us
Areas of Practice
Auto, Motorcycle, and Bike Accidents
Wrongful Death
Uninsured Motorist
Slip and Fall
Dog Bites
Products Liability
Business Law
Intake Form
Contact Us
Intake Form
INTAKE FORM
Intake Form
Full Name
Home Address
City, State, Zip
Home Phone
Cell Phone
Did you have wage loss?
Yes
No
Your Title
Accident Information
MVA
Slip & Fall
Product
Dog Bite
Date of Accident
New Field:
Description of what happened
Your Insurance Company Name
Insurance Company Address
Adjuster Name
Adjuster Phone
Claim Number
List injuries sustained in accident
Accident Report?
Yes
No
Report #
Person who caused accident
Person who caused accident
New Field:
New Field:
Their Insurance
Their Insurance Address
Their Adjuster
New Field:
Name/Address of any witnesses
Has your property damage been repaired?
Yes
No
Where
Estimate of Repair
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559-733-3858
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Home
About Us
Areas of Practice
Intake Form
Contact Us
Contact Information
Address:
500 South Chinowth St. Suite 103
Visalia, CA 93277
Phone:
(559) 733-3858
Fax: (559) 733-3985
Email:
Joseph C. Durante, Jr.
Attorney at Law
joe@jcdlawoffices.com
Melissa Martin
Legal Assistant
melissa@jcdlawoffices.com
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